1
|
Srikrishnaraj A, Lanting BA, Burton JP, Teeter MG. The Microbial Revolution in the World of Joint Replacement Surgery. JB JS Open Access 2024; 9:e23.00153. [PMID: 38638595 PMCID: PMC11023614 DOI: 10.2106/jbjs.oa.23.00153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Background The prevalence of revision surgery due to aseptic loosening and periprosthetic joint infection (PJI) following total hip and knee arthroplasty is growing. Strategies to prevent the need for revision surgery and its associated health-care costs and patient morbidity are needed. Therapies that modulate the gut microbiota to influence bone health and systemic inflammation are a novel area of research. Methods A literature review of preclinical and clinical peer-reviewed articles relating to the role of the gut microbiota in bone health and PJI was performed. Results There is evidence that the gut microbiota plays a role in maintaining bone mineral density, which can contribute to osseointegration, osteolysis, aseptic loosening, and periprosthetic fractures. Similarly, the gut microbiota influences gut permeability and the potential for bacterial translocation to the bloodstream, increasing susceptibility to PJI. Conclusions Emerging evidence supports the role of the gut microbiota in the development of complications such as aseptic loosening and PJI after total hip or knee arthroplasty. There is a potential for microbial therapies such as probiotics or fecal microbial transplantation to moderate the risk of developing these complications. However, further investigation is required. Clinical Relevance Modulation of the gut microbiota may influence patient outcomes following total joint arthroplasty.
Collapse
Affiliation(s)
- Arjuna Srikrishnaraj
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Brent A. Lanting
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Jeremy P. Burton
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Matthew G. Teeter
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| |
Collapse
|
2
|
Evaluating the Functional and Psychological Outcomes Following Periprosthetic Femoral Fracture After Total Hip Arthroplasty. Arthroplast Today 2022; 18:57-62. [PMID: 36262668 PMCID: PMC9574344 DOI: 10.1016/j.artd.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 06/29/2022] [Accepted: 08/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background A fall after total hip arthroplasty (THA) that results in a periprosthetic femoral fracture (PPF) can have devastating functional and psychological consequences in older adults. There are few studies that have evaluated both functional and psychological outcomes of PPF post-THA in the same cohort. Methods This is a retrospective study of 130 people who underwent revision THA between 2005 and 2019 due to PPF. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC), Harris Hip Score (HHS), and Short Form-12 (SF-12) assessed physical function, hip joint function, and psychological well-being, respectively. Descriptive statistics using means and standard deviation or frequencies and percentages were used to define the sample. The association between baseline demographic, clinical, and surgical factors on WOMAC, HHS, and SF-12 scores at 1-year post-PPF surgery was modelled using multivariable linear regression. The mean age (n = 130) was 80.6 ± 9.0 years, and 55.4% (n = 72) were female. The mortality rate was 15.4% (n = 20) at 1-year post-PPF surgery. One-year follow-up data were available for 35.4% (n = 46) of patients. Results The WOMAC (n = 37), HHS (n = 32), and SF-12 mental component summary (n = 46) scores at 1-year post-PPF surgery were 67.9 ± 20.3, 78.3 ± 15.0, and 52.7 ± 9.1, respectively. No significant association was found among age, gender, previous history of lower extremity surgery, Vancouver classification, and femoral bone grafting on WOMAC, HHS, and SF-12 scores. Conclusions Our study found that patients with PPF have fair hip joint function, poor physical function and psychological well-being, and a high mortality rate at 1-year post-PPF surgery.
Collapse
|
3
|
Is Stem Revision Necessary for Vancouver B2 Periprosthetic Hip Fractures? Analysis of Osteosynthesis Results from 39 Cases. J Clin Med 2021; 10:jcm10225288. [PMID: 34830570 PMCID: PMC8625122 DOI: 10.3390/jcm10225288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022] Open
Abstract
Although stem revision is recommended for Vancouver B2 periprosthetic hip fractures (PPHFs), there has recently been a debate whether, under certain conditions, they could be treated by osteosynthesis alone. This study aimed to describe the medium-term clinical and radiological results of several patients with V-B2 fractures treated via osteosynthesis. A retrospective study of patients with V-B2 PPHF treated by osteosynthesis without stem revision, operated on between 2009 and 2019, was performed. The type of arthroplasty, type of stem, ASA, Charlson Comorbidity Index (CCI), medical and implant complications, reoperation rate, first-year mortality, radiological results (consolidation time), and functional results were analyzed. Thirty-nine patients were included. Their average age was 78.82 years. Most of the patients presented ASA ≥ 3 (35/39) and CCI ≥ 5 (32/39). Radiological consolidation was achieved in 93.5% of patients, with an average consolidation time of 92.93 days. The average Parker test score before admission was 5.84 while the current one was 4.92 (5.16 years follow-up). Osteosynthesis without stem revision is a valid surgical alternative in certain types of patients with V-B2 PPHF, depending on previous mobility, fracture pattern (anatomical reconstruction possible), anesthetic risk, comorbidities, and previous hip pain.
Collapse
|
4
|
González-Martín D, Pais-Brito JL, González-Casamayor S, Guerra-Ferraz A, Martín-Vélez P, Herrera-Pérez M. Periprosthetic Hip Fractures With a Loose Stem: Open Reduction and Internal Fixation Versus Stem Revision. J Arthroplasty 2021; 36:3318-3325. [PMID: 34052099 DOI: 10.1016/j.arth.2021.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It is recommended revision for periprosthetic hip fractures (PPHF) with a loose stem. However, several authors have argued that under certain conditions, this fracture could be treated using osteosynthesis. The aim is to compare stem revision versus internal fixation in the treatment of PPHF with a loose stem. METHODS All patients with PPHF with a loose stem treated by osteosynthesis and stem revision between January 2009 and January 2019 were included. We assessed hospital stay, American Society of Anesthesiologists, Charlson comorbidity index, surgery time, blood transfusion, complications, reoperation rate, first-year mortality, radiological, and functional results. RESULTS A total of 57 patients were included (40 osteosyntheses and 17 stem revision), with an average follow-up time of 3.1 years. Their mean age was 78.47 years (R 45-92). In the osteosynthesis group, fewer patients required blood transfusion (32.5% vs. 70.6%), surgical times were shorter (108 minutes vs. 169 minutes), and the cost was lower, both in terms of total cost (€14,239.07 vs. €21,498.45 and operating room cost (€5014.63 vs. €8203.34). No significant differences were found between the groups in terms of complications, reoperation rate, or functional outcomes. CONCLUSION Compared with stem revision, osteosynthesis requires less surgery time, has a lower need for blood transfusions, and a reduced hospital cost. Stem revision remains the treatment of choice in PPHF with a loose stem, but in V-B2 fractures in elderly patients with low functional demand, high anesthetic risk (American Society of Anesthesiologists ≥3), and many comorbidities (Charlson comorbidity index ≥5) in whom anatomic reconstruction is possible, osteosynthesis can be a viable option. EVIDENCE LEVEL Historical cohorts. Level III.
Collapse
Affiliation(s)
- David González-Martín
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain
| | - José Luis Pais-Brito
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain.
| | | | - Ayron Guerra-Ferraz
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain
| | - Pablo Martín-Vélez
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain
| | - Mario Herrera-Pérez
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain
| |
Collapse
|
5
|
Zheng H, Gu H, Shao H, Huang Y, Yang D, Tang H, Zhou Y. Treatment and outcomes of Vancouver type B periprosthetic femoral fractures. Bone Joint J 2020; 102-B:293-300. [PMID: 32114805 DOI: 10.1302/0301-620x.102b3.bjj-2019-0935.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Vancouver type B periprosthetic femoral fractures (PFF) are challenging complications after total hip arthroplasty (THA), and some treatment controversies remain. The objectives of this study were: to evaluate the short-to-mid-term clinical outcomes after treatment of Vancouver type B PFF and to compare postoperative outcome in subgroups according to classifications and treatments; to report the clinical outcomes after conservative treatment; and to identify risk factors for postoperative complications in Vancouver type B PFF. Methods A total of 97 consecutive PPFs (49 males and 48 females) were included with a mean age of 66 years (standard deviation (SD) 14.9). Of these, 86 patients were treated with surgery and 11 were treated conservatively. All living patients had a minimum two-year follow-up. Patient demographics details, fracture healing, functional scores, and complications were assessed. Clinical outcomes between internal fixation and revisions in patients with or without a stable femoral component were compared. Conservatively treated PPFs were evaluated in terms of mortality and healing status. A logistic regression analysis was performed to identify risk factors for complications. Results In surgically treated patients, all fractures united and nine complications were identified. The mean postoperative Visual Analogue Scale (VAS) for pain was 1.5 (SD 1.3), mean Parker Mobility Score (PMS) was 6.5 (SD 2.4), and mean Harris Hip Score (HHS) was 79.4 (SD 16.2). Among type B2 and type B3 fractures, patients treated with internal fixation had significantly lower PMS (p = 0.032) and required a longer time to heal (p = 0.012). In conservatively treated patients, one-year mortality rate was 36.4% (4/11), and two patients ultimately progressed to surgery. Young age (p = 0.039) was found to be the only risk factor for complications. Conclusion The overall clinical outcome among Vancouver type B PFF was satisfactory. However, treatment with internal fixation in type B2 and B3 fractures had a significantly longer time to heal and lower mobility than revision cases. Conservative treatment was associated with high rates of early mortality and, in survivors, nonunion. This probably reflects our selection bias in undertaking surgical intervention. In our whole cohort, younger patient age was a risk factor for postoperative complications in Vancouver type B PFF. Cite this article: Bone Joint J 2020;102-B(3):293–300
Collapse
Affiliation(s)
- Hanlong Zheng
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hangyu Gu
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hongyi Shao
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yong Huang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Dejin Yang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hao Tang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| |
Collapse
|
6
|
Kang JS, Moon KH, Ko BS, Roh TH, Na Y, Youn YH, Park JH. Prognostic Factors and Clinical Outcomes after Treatment of Periprosthetic Femoral Fractures Using a Cable-plate. Hip Pelvis 2019; 31:166-173. [PMID: 31501766 PMCID: PMC6726864 DOI: 10.5371/hp.2019.31.3.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/24/2019] [Accepted: 07/03/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose To analyze prognostic factors for the treatment of periprosthetic femoral fractures (PFFs) using the cable-plate construct. Materials and Methods A retrospective review of a consecutive series of 41 PFFs treated by osteosynthesis using the cable-plate system. The mean age of patients was 67.3±12.1 years (range, 42-86 years) and the mean follow-up period was 31.5±11.6 months (range, 12–58 months). Fresh frozen cortical strut allografts were leveraged in three cases for additional stability. Prognostic factors that may potentially affect clinical outcomes were analyzed. Results At the time of final follow-up, fracture union was obtained in 29 hips (70.7%; Group I) after an average of 13.5 weeks (range, 12–24 weeks). Healing failure after surgical treatment was observed in 12 cases (29.3%; Group II), including delayed union (n=10) cases and nonunion (n=2). Factors significantly associated with fracture union included fracture pattern (P=0.040), plate overlap percentage to stem length (P<0.001) and T-score at the preoperative bone mineral density (P=0.011). Transverse-type fractures around or just distal to a well-fixed femoral stem were observed in six cases (50.0%) of Group II. Conclusion The cable-plate osteosynthesis of PFFs should be performed with caution in transverse-type fractures or in cases with severe osteoporosis. Fixation with sufficient plate overlap to stem length may be critical to prevent healing failure.
Collapse
Affiliation(s)
- Joon Soon Kang
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| | - Kyoung-Ho Moon
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| | - Bong Sung Ko
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| | | | - Yeop Na
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| | - Yung-Hun Youn
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| | - Joo Hyun Park
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| |
Collapse
|
7
|
Smitham PJ, Carbone TA, Bolam SM, Kim YS, Callary SA, Costi K, Howie DW, Munro JT, Solomon LB. Vancouver B2 Peri-Prosthetic Fractures in Cemented Femoral Implants can be Treated With Open Reduction and Internal Fixation Alone Without Revision. J Arthroplasty 2019; 34:1430-1434. [PMID: 30956048 DOI: 10.1016/j.arth.2019.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study is to assess the outcomes of 52 consecutive Vancouver B2 peri-prosthetic fractures around cemented polished double-tapered stems treated by open reduction and internal fixation in 2 trauma centers in 2 countries. METHODS Outcomes included modified Harris Hip Score (mHHS), Harris Pain Score, and return to pre-injury mobility. Fracture healing was assessed; implant subsidence measured and complications including re-operations reported. RESULTS No patient was lost to follow-up. Median patient age at operation was 82 years (range 43-98); Harris pain scores showed minimal pain (median 42, range 10-44) at latest follow-up. Median total subsidence at 1 year was 1.1 mm (range 0-5.4), the majority of which occurred within the cement mantle. No subsequent femoral stem revision was required (median 2.9 years, 0-10); however, there were 3 re-operations: 1 re-operation for pre-existing recurrent dislocation involving head liner exchange and 2 for repeat fixation due to metal fatigue. Two additional fractures occurred below the new plating, requiring further plating whilst still retaining the original stems. CONCLUSION Anatomical reduction and open reduction and internal fixation of Vancouver B2 peri-prosthetic fractures should be considered as an appropriate treatment solution for frail elderly patients with a peri-prosthetic fracture around cemented polished double-tapered stems.
Collapse
Affiliation(s)
- Peter J Smitham
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tania A Carbone
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Scott M Bolam
- Department of Orthopedic Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Young S Kim
- Department of Orthopedic Surgery, Dongguk University Hospital, Gyeongju, Gyeongsangbuk-do, Republic of Korea
| | - Stuart A Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kerry Costi
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Donald W Howie
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jacob T Munro
- Department of Orthopedic Surgery, Dongguk University Hospital, Gyeongju, Gyeongsangbuk-do, Republic of Korea
| | - Lucian B Solomon
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
8
|
[Periprosthetic fractures of the acetabulum and femur : Causes-classification-treatment algorithms]. DER ORTHOPADE 2019; 48:322-329. [PMID: 30820591 DOI: 10.1007/s00132-019-03696-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Both increasing implantation numbers of total hip replacements and demographic change with higher populations of older people, indicate that there will be an increase in periprosthetic fractures in the future. CAUSES Falls in the home environment are the most common cause. Significant co-factors include reduced patient coordination, reduced bone quality, or implant-associated factors such as local osteolysis or pre-existing implant loosening. CLASSIFICATION In the classification of periprosthetic fractures of the femur, the Vancouver classification has prevailed in recent years, which in addition to a description of the localization of the fracture also considers the stability of the prosthesis and bone quality. Based on this, therapeutic algorithms have been developed that can vary from the conservative approach via osteosynthetic options to a replacement of the prosthesis. In order to allow the description of periprosthetic fractures on all joints, the Vancouver classification has been extended to the UCS classification by including the AO/OTA bone and joint coding system. In the selection of the treatment method, the consideration of individual patient factors such as activity level and secondary diagnoses is essential. Based on the established classifications, the importance of the different therapeutic methods is presented.
Collapse
|
9
|
King SW, Lamb JN, Cage ES, Pandit H. Periprosthetic femoral fractures following total hip and total knee arthroplasty. Maturitas 2018; 117:1-5. [PMID: 30314554 DOI: 10.1016/j.maturitas.2018.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/20/2018] [Accepted: 08/24/2018] [Indexed: 11/25/2022]
Abstract
Total joint arthroplasties are increasing worldwide in both frequency and prevalence. When successful, they offer great improvements in quality of life. However, fractures around implants are often difficult to manage and require prolonged inpatient stays in tertiary hospitals. Management may differ between surgeons, but most patients will be managed surgically if mobility or joint stability is threatened. Those affected are often at higher risk from surgery, are frailer and at higher risk of mortality and a lifelong reduction in mobility. The incidence of these fractures is increasing, and patients should appreciate the risk and implications of this recognised complication of joint arthroplasty.
Collapse
Affiliation(s)
- Samuel W King
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Jonathan N Lamb
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK; Leeds Institutes of Rheumatology and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Rd, Leeds, LS7 4SA, UK.
| | - Emily S Cage
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK; Indiana University School of Medicine, 340 West 10th Street, Indianapolis, IN 46202, USA
| | - Hemant Pandit
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK; Leeds Institutes of Rheumatology and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Rd, Leeds, LS7 4SA, UK
| |
Collapse
|
10
|
Capone A, Congia S, Civinini R, Marongiu G. Periprosthetic fractures: epidemiology and current treatment. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2017; 14:189-196. [PMID: 29263732 PMCID: PMC5726208 DOI: 10.11138/ccmbm/2017.14.1.189] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Periprosthetic fractures are becoming increasingly frequent due to aging population and growing number of total joint replacements involving joints different from hip and knee, such as shoulder and elbow. The treatment of these fractures still represents one of the major challenges for the orthopedic surgeon. Despite all efforts to understand and treat these patients, high rate of failure and mortality are still reported. In this review, the epidemiology of periprosthetic fractures, risk factors and results of surgical treatment are disclosed. Moreover, we propose a treatment algorithm based on the findings of the New Unified Classification System.
Collapse
Affiliation(s)
- Antonio Capone
- Orthopedic Clinic, Department of Special Surgical Science, University of Cagliari, Ospedale Marino, Cagliari, Italy
| | - Stefano Congia
- Orthopedic Clinic, Department of Special Surgical Science, University of Cagliari, Ospedale Marino, Cagliari, Italy
| | - Roberto Civinini
- Orthopedic Clinic, Department of Special Surgical Science, University of Florence, CTO, Florence, Italy
| | - Giuseppe Marongiu
- Orthopedic Clinic, Department of Special Surgical Science, University of Cagliari, Ospedale Marino, Cagliari, Italy
| |
Collapse
|