Revision rate is higher in patients with periprosthetic femur fractures following revision arthroplasty in comparison with ORIF following our algorithm: a two-center 1 analysis of 129 patients

Abstract Purpose Effective therapy of periprosthetic femur fractures of the hip (PPF) are challenging due to patients’ frailty and complexity of fracture patterns. The aim of this cohort study was to analyze the radiological and functional outcome following PPF. Methods A retrospective, multicenter study in the period 2009–2019 of patients with PPF at two level I trauma centers in Germany was performed. PPF were classified according to the Vancouver classification system. Demographic data, American Society of Anesthesiologists (ASA) classification, type of surgery, complications, and reoperation rate were obtained from patient records. The functional outcome was assessed by the modified Harris-Hip Score (mHHS), general health using the EQ-5D, and radiological outcome by Beals & Tower (B&T) criteria. Results A total of 129 patients with a mean age of 79 years (range 43–102) were included. 70% of all patients were female and 68% of the patients had an ASA score ≥ 3. 20 patients suffered from a Vancouver A, 90 from a Vancouver B and 19 from a Vancouver C fracture. 14% of the patients died within the first 2 years after surgery. The reoperation rate after open reduction and internal fixation (ORIF) (n = 60) was 8% and after revision arthroplasty (RA) (n = 47) 30% (OR 3.4, 95% CI [1.21–10.2]). Mean mHHS (n = 32) was 53 ± 19.4 and EQ-VAS was 50 ± 24.6. According to B&T criteria, 82% of patients treated with ORIF (n = 17) and 62% after RA (n = 13) showed an excellent outcome. Conclusion Patients with a PPF of the hip are elderly and at increased operative risk. In cases with a stable prosthesis, ORIF provides good radiological outcome with low reoperation rates. In case of RA, the risk for revision surgery is higher.

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Confounding variables affecting long term results of standard two screw cephalomedullary nail in intertrochanteric fractures of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205569 ◽

2020 ◽

Vol 7 (1) ◽

pp. 103

Author(s):

Rajeev Shukla ◽

Adhir Jain ◽

Pranav Mahajan ◽

Ravikant Jain

Keyword(s):

Functional Outcome ◽

Final Outcome ◽

Long Term Results ◽

Harris Hip Score ◽

Walking Ability ◽

Treatment Technique ◽

Trochanteric Fractures ◽

Excellent Outcome ◽

Femur Fractures

Background: Inter trochanteric fractures of femur are common fractures in the elderly. The aim of the study was to assess the long-term functional outcome of patients treated with trochanteric fixation nail (TFN) for inter trochanteric femur fractures and to determine variables which affect the final outcome of surgery at the end of five years.Methods: The study was done at tertiary centre in central India with 152 patients who sustained intertrochanteric femur fracture. The patients were followed up at 6 weeks, 6 months, 1 year, 2 years and 5 years after the surgery. The assessment of pain, functional activity, walking ability and range of motion were assessed by Harris hip score at 6 months, 1 year, 2 years and 5 years.Results: The good/excellent outcome at the end of 5 years was found in 84% of cases. Patients with age less than 65 years and male patients had better outcome at the end of five years. Some of the complications encountered with this type of implant were z effect, delayed union, screw back-out/breakage, varus collapse which affected the final outcome.Conclusions: TFN is effective treatment technique for inter trochanteric fractures of femur worldwide. There are some complications which can occur with this type of implant in early post-operative period but still long-term follow-up of patients suggested that the fracture pattern, preoperative mobility status, timing of surgery, post op mobilization also plays a key role in determining functional outcome of patients.

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Calcar buttressed screw fixation for femoral neck fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185337 ◽

2018 ◽

Vol 5 (1) ◽

pp. 145

Author(s):

K. K. Arvind Manoj ◽

R. Karthik ◽

A. Vishnu Sankar

Keyword(s):

Femoral Neck ◽

Functional Outcome ◽

Femoral Neck Fracture ◽

Screw Fixation ◽

Femoral Neck Fractures ◽

Fixation Strength ◽

Harris Hip Score ◽

Average Period ◽

Excellent Outcome ◽

Neck Fracture

Background: The incidence of neck of femur fracture among elderly population is increasing day by day. Femoral neck fracture has always been an unsolved fracture as far as treatment and results are concerned. There are different views regarding the optimal method of internal ﬁxation in femoral neck fractures. Biomechanical data from literature suggest that calcar ﬁxation is superior to central screws placement. This study aims to analyse the functional and radiological outcome of femoral neck fractures treated by calcar buttressed screw fixation described by Filipov as biplane double supported screw fixation.Methods: This is a prospective study conducted in our institution from May 2015 to May 2018.The study included 43 patients (31 male, 12 female) with femoral neck fracture. Three 6.5-mm cannulated screws were laid in two medially diverging oblique planes. The distal and the middle screws were supported on the calcar. The distal screw had additional support on the posterior neck cortex. Patients were followed up for average period of 2 years. Functional outcome was evaluated using Harris Hip score.Results: Bone union occurred in 40 patients (93%) with average period of 3-4 months. 51.2% of cases had excellent outcome. 23.2% of cases had good and 16.3% of cases had fair outcome. 9.3% of cases ended with poor outcome. Non union was reported in 3 patients (7%) and AVN in one patient. Various factors like age, Garden and Pauwel fracture types, time of presentation and time of surgery were statistically significant to the final functional outcome in our study.Conclusions: By providing additional calcar buttress compared to conventional method, this technique of screw fixation enhances femoral neck fracture fixation strength and reduces the fixation failure.

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Assessment of efficacy of locking compression plate in distal femur fractures

International Surgery Journal ◽

10.18203/2349-2902.isj20213214 ◽

2021 ◽

Author(s):

Faizal Ali A. A. ◽

Govind Karunakaran ◽

Hijas Hameed

Keyword(s):

Functional Outcome ◽

Distal Femur ◽

Oxford Knee Score ◽

Locking Compression Plate ◽

Knee Score ◽

Medial Condyle ◽

Excellent Outcome ◽

Femur Fractures ◽

Articular Fractures ◽

Compression Plate

Background: Distal femur fractures account for an estimated 6% of all femur fractures. Our study aims at evaluating the functional and radiological outcome in distal femur fractures treated with locking compression plate (DF-LCP).Methods: Patients undergoing LCP were assessed postoperatively both functionally and radiologically. Oxford Knee Score was used to assess the functional outcome. With a maximum score of 48, a score of more than 41 is scaled as excellent, 34 to 40 as good functional status, 27 to 33 as fair and score less than 27 as poor functional result.Results: Extra-articular fractures were the commonest (66.7%) type of fractures [simple-6.7%; metaphyseal wedge-20%; metaphyseal complex-40%] followed by complete articular fractures (26.7%) [Simple articular metaphyseal comminution-16.7%; metaphyseal and intra-articular comminution-10%] and partial articular fractures (6.7%) [Medial condyle-3.3%; coronal plane-3.3%]. Most of them had right sided femur injury (66.7%) and had history of fall (70%). Radiologically, 90% exhibited no complications and had united appropriately. Functionally the mean oxford knee score was 41.53±1.69 which ranged from a score of 38 to a maximum of 44. Highest proportion i.e., 63.3% had excellent outcome followed by good functional outcome and none showed fair or poor outcomes.Conclusions: LCP has shown very good radiological and functional outcomes with hundred percent union of the distal femur fractures. Hence it can be used successfully in distal femur fractures.

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Evaluation of clinical results and complications of internal fixation of intertrochanteric femur fracture with proximal femoral nail antirotation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190531 ◽

2019 ◽

Vol 5 (2) ◽

pp. 283 ◽

Cited By ~ 1

Author(s):

Manish Raj ◽

S. P. S. Gill ◽

Akashdeep Singh ◽

Ajay Kumar Rajput ◽

Santosh Kumar Singh

Keyword(s):

Functional Outcome ◽

Varus Deformity ◽

Clinical Results ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Significant Treatment ◽

Femur Fractures ◽

Femoral Nail ◽

Proximal Femoral Nail Antirotation

Background: The purpose of the present study was to evaluate the theoretical advantages of the proximal femoral nail antirotation in cases of intertrochanteric fractures and also whether it actually alters the eventual functional outcome of the patient.Methods: The present study includes a total 30 patients with intertrochanteric femur fractures managed with proximal femoral nail antirotation between December 2014 to November 2016. In all patients similar standard physical rehabilitation therapy were followed. All complications including intra and postoperative were assessed and recorded. The patients were followed up for over 24 months. Functional outcome was assessed using the Harris hip score.Results: All of 30 cases of intertrochanteric fracture got united with good anatomical position and average time of fracture union was 14 weeks. Postoperative complications included 2 degree varus deformity (n=1, 3%), calcification at tip of greater trochanter (n=4, 13%), sensitivity over TFL (n=2, 7%), medial thigh pain (n=3, 10%). 10 patients developed femoral shortness (mean=0.22 cm, range from 0-1 cm). Average harris hip score at the end of study showed mean value of 87, ranged from 65 to 94 with almost 22 (73%) patients showing excellent or good outcome.Conclusions: Proximal femoral nail antirotation (PFNA) represents a significant treatment option in management of intertrochanteric fractures with low complication rate.

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Functional outcome of unstable intertrochanteric fractures managed with proximal femoral nail: a prospective analysis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184391 ◽

2018 ◽

Vol 4 (6) ◽

pp. 945

Author(s):

C. Joney Mandice ◽

Raship Khan ◽

Heber Anandan

Keyword(s):

Functional Outcome ◽

Hip Fractures ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Femur Fractures ◽

Efficient Management ◽

Femoral Nail ◽

Early Return ◽

Unstable Intertrochanteric Fracture

Background: Hip fractures are a growing concern for the orthopedic surgeons all over the world because the incidence of hip fractures is increasing dramatically and these fractures impose a significant challenge in their efficient management. The aim of the study was to prospectively analyze the functional outcome of unstable intertrochanteric fractures managed with ‘proximal femoral nail’.Methods: In our institution, we have selected 24 cases of unstable intertrochanteric fractures for this prospective study. All cases enrolled were managed with the proximal femoral nail. These cases were studied from the mechanism of injury, classification, and treatment with the proximal femoral nail and their surgical and functional outcome with or without residual comp.Results: Patients were followed up for an average period of 8.58 months. The mean Harris hip score was 88.75 at 6th month. The score was excellent in 12 patients, good in 10 patients, fair in 1 patient and poor in 1 patient. In our study of 24 patients with unstable intertrochanteric fracture, the average age incidence was 54.64 years. In the present study male: female was 5:3.Conclusions: In unstable proximal femur fractures, PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation and early return to work.

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Demographics, Treatment, and Cost of Periprosthetic Femur Fractures: Fixation Versus Revision

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320939550 ◽

2020 ◽

Vol 11 ◽

pp. 215145932093955

Author(s):

Katelyn Ragland ◽

Rebecca Reif ◽

Saleema Karim ◽

Kevin W. Sexton ◽

Steven M. Cherney ◽

...

Keyword(s):

Revision Arthroplasty ◽

Geographic Region ◽

Teaching Hospitals ◽

Hospital Type ◽

Total Cost ◽

Patient Demographics ◽

Femur Fractures ◽

Hip And Knee Arthroplasty ◽

Periprosthetic Femur Fractures ◽

Procedure Type

Introduction: Periprosthetic femur fractures (PPFX) are complications of both total hip and knee arthroplasty and may be treated with open reduction and internal fixation (ORIF) or revision arthroplasty. Differences in treatment and fracture location may be related to patient demographics and lead to differences in cost. Our study examined the effects of demographics and treatment of knee and hip PPFXs on length of stay (LOS) and cost. Methods: Of all, 932 patients were identified with hip or knee PPFXs in the National Inpatient Sample from January 2013 to September 2015. Age, gender, race, mortality, comorbidity level, LOS, total cost, procedure type, geographic region, and hospital type were recorded. A generalized linear regression model was conducted to analyze the effect of fracture type on LOS and cost. Results: Differences in gender (66% vs 83.7% female, P < .01), comorbidities (fewer in hips, P < .01), and costs (US$30 979 vs US$27 944, P < .01) were found between the hip and knee groups. Knees had significantly higher rates of ORIF treatment (80.7% vs 39.1%) and lower rates of revision arthroplasties (19.3% vs 60.9%) than hip PPFXs ( P < .01). Within both groups, patients with more comorbidities, revision surgery, and blood transfusions were more likely to have a longer LOS and higher cost. Conclusion: Periprosthetic femur fractures patients are not homogenous and treatment varies between hip and knee locations. For knee patients, those treated with ORIF were younger, with fewer comorbidities than those treated with revision. Conversely, hip patients treated with ORIF were older, with more comorbidities than those treated with revision. Hips had higher costs than knees, and cost correlated with revision arthroplasty and more comorbidities. In both hip and knee groups, longer LOS was associated with more comorbidities and being treated in urban teaching hospitals. Total cost had the strongest associations with revision procedures as well as number of comorbidities and blood product use.

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Evaluation of functional outcome of intertrochanteric femur fractures treated with proximal femoral locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20213199 ◽

2021 ◽

Author(s):

Maruti Bhujangrao Lingayat ◽

Pratik P. Rathod

Keyword(s):

Functional Outcome ◽

Locking Compression Plate ◽

Harris Hip Score ◽

Superficial Infection ◽

Femur Fractures ◽

Compression Plate ◽

Average Operative Time ◽

One Year ◽

Time Required

Background: The objective was to find out the clinical and functional outcome of intertrochanteric femur fractures treated with proximal femoral locking compression plate (PFLCP).Methods: The study was conducted on patients who underwent fixation of intertrochanteric femur fractures with PFLCP in department of orthopedics, GMCH, Aurangabad from January 2020 to January 2021. The patients were assessed clinically and functionally using Harris hip score and radiological evaluation at three, six and nine months.Results: At one year follow up, two patients had varus collapse, one had superficial infection and one had screw cut out. The mean Harris hip score at one month was 69.46 (52-76), at three months was 78.6 (58-88) and at nine months was 87.6 (64-96). The average operative time was 86.23 minutes (60-128 minutes), the average blood loss was 207.5 ml (170-250 ml) and the average time required for union was 15.16 weeks (10-24 weeks).Conclusions: Intertrochanteric fractures treated with PFLCP provided a strong angular stable construct and showed satisfactory outcomes.

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Evaluation of functional outcome of displaced fracture neck of femur in elderly treated with cemented bipolar prosthesis by modified Harris hip score

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211610 ◽

2021 ◽

Vol 7 (3) ◽

pp. 561

Author(s):

Shivakumar B. Kerakkanavar ◽

Deepak P. Kaladagi ◽

Nagesh B. Sanakal ◽

Pundaleekappa S. Kaladagi ◽

Praveenkumar A. Hongal

Keyword(s):

Elderly Patients ◽

Functional Outcome ◽

Hip Prosthesis ◽

Limb Lengthening ◽

Harris Hip Score ◽

Neck Of Femur ◽

Fracture Neck Of Femur ◽

Femur Fractures ◽

Modified Harris Hip Score ◽

Displaced Fracture

Background: The current research was conducted to determine the functional outcome of the displaced fracture neck of femur in elderly patients treated with cemented bipolar hip prosthesis.Methods: The present research was a prospective study of 44 cases of displaced fracture neck of femur admitted to our institute between October 2017 and October 2019. Cases were chosen on the basis of inclusion and exclusion criteria. Cases were surgically treated with cemented bipolar hip hemiarthroplasty and functional findings were recorded with modified Harris hip score.Results: In our series of 44 cases there were 30 females and 14 males, with a maximum age of 92 years, minimum age of 65 years, and the average age was 72.72 years. At one-year follow-up, the average modified Harris hip score was 86.75% (maximum score of 95 and a minimum score of 66), overall, 20 patients (45.46%) achieved excellent, 16 patients (36.36%) achieved good, 5 patients (11.36%) achieved fair and 3 patients (6.82%) achieved poor results. 81.82% of the patients returned to the pre-fracture level of activity and independent ambulation. Patients had few complications like limb length discrepancy, 36.3% of patients had limb lengthening between 1 to 1.5 cm.Conclusions: In elderly patients with displaced neck femur fractures, cemented bipolar hip prosthesis provides good functional outcome. However further study for a longer period in a larger sample with a direct comparison between the cemented versus uncemented groups is required.

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Can proximal femoral nailing of unstable trochanteric fractures help to regain pre-injury functional status in Indian rural patients? A prospective study of functional outcome of unstable intertrochanteric fractures with proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172079 ◽

2017 ◽

Vol 3 (4) ◽

pp. 728

Author(s):

Shankar Linga S. ◽

Janardhana Aithala P. ◽

Amarnath Savur

Keyword(s):

Functional Outcome ◽

Harris Hip Score ◽

Walking Ability ◽

Trochanteric Fractures ◽

Femoral Nailing ◽

Femur Fractures ◽

Time Period ◽

Hip Screw ◽

A Prospective Study ◽

Proximal Femoral Nailing

Background: In view of the high incidence of implant failure and varus collapse seen in unstable inter trochanteric femur fractures treated with dynamic hip screw (DHS), proximal femoral nailing (PFN) has gained popularity.1,2 However there is limited literature regarding functional outcome following PFN especially in Indian patients. In this study, our aim was to assess functional outcome following PFN of unstable inter trochanteric femur fractures which includes the ability to sit cross leg and squat.Methods: This prospective observational study was done at the associated hospitals of KMC Mangalore, spanning a time period of around 2 years, from October 2014 to July 2016. All patients who presented with isolated closed unstable inter-trochanteric fractures were included in the study. Patients were treated with proximal femoral nailing and followed up for a minimum period of 6 months. Outcome measures included Harris hip score, walking status and ability to sit cross leg and squat.Results: 40 consecutive patients (Mean age 61 years, range 25-95) were included in the study, all fractures united within 6 months. As per Harris hip score, 25 patients (62.5%) had excellent or good results, 8 patients (20%) had fair and 7 patients (17.5%) had poor results. 74% (20 out of 27) regained their gainful working status. 80% (24 out of 30) were able to squat easily or with some difficulty and 74% (20 out of 27) patients were able to sit crossed leg with or without difficulty. 82% (23 out of 28) regained their unassisted walking status.Conclusions: For unstable inter trochanteric femur fracture PFN gives good results in terms of union, walking ability and majority of the patients regained their pre injury activity status including squatting and cross leg sitting.

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Functional analysis of cemented bipolar hemiarthroplasty with medial calcar augmentation for unstable intertrochanteric fractures in elderly

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175662 ◽

2017 ◽

Vol 4 (1) ◽

pp. 141

Author(s):

Sivabalan T. ◽

Thirunarayanan V. ◽

Senthil Kumar S. ◽

Ramprasath D. R. ◽

Basheer Ahmed S.

Keyword(s):

Functional Outcome ◽

Intertrochanteric Fracture ◽

The Elderly ◽

Fracture Pattern ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Intertrochanteric Fractures ◽

Excellent Outcome ◽

Unstable Intertrochanteric Fracture ◽

Cemented Bipolar Hemiarthroplasty

Background: Intertrochanteric fracture is one of the most common fractures among the elderly osteoporotic population, constituting about 50% of hip fractures. These fractures are managed either by fixation using dynamic hip screw (DHS), proximal femur nail (PFN) or by replacement, based on the stability of fracture pattern, age of the patient, quality of bone and associated co-morbid conditions. Prosthetic replacement which is routinely done for femoral neck fractures requires modification when done for trochanteric fractures to improve stability. This study aims to analyse the short term functional outcome of cemented bipolar hemiarthroplasty with medial calcar augmentation for unstable intertrochanteric fractures in elderly.Methods: Our study includes 60 patients of age more than 70 years admitted in our institution during June 2012 to September 2016 with unstable intertrochanteric fractures. All patients operated through posterior approach to hip and cemented hemiarthroplasty with medial calcar augmentation with bone graft was done. Patients were followed up for an average of period of 2 years. Functional outcome was evaluated with Harris Hip score.Results: 28% of cases had excellent outcome. 43% of cases had good and 23% of cases had fair outcome. 2% of cases ended with poor outcome. The in-hospital mortality rate was 3.3%. The survival rate of the patients in this study at the end of one year is 85%. Conclusions: Cemented bipolar hemiarthroplasty with medial calcar augumentation can be considered as a good primary option for elderly unstable intertrochanteric fracture patients with osteoporotic bones and associated co-morbidities.

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