scholarly journals Atypical periprosthetic femoral fracture associated with long-term bisphosphonate therapy

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Dávid Dózsai ◽  
Tamás Ecseri ◽  
István Csonka ◽  
István Gárgyán ◽  
Péter Doró ◽  
...  
Keyword(s):  
Femoral Fracture ◽  
Case Reports ◽  
Femoral Stem ◽  
Femoral Fractures ◽  
Atypical Femoral Fracture ◽  
Periprosthetic Fractures ◽  
Periprosthetic Femoral Fracture ◽  
Mineral Research ◽  
Periprosthetic Femoral Fractures

Abstract Background Atypical femoral fracture is one of the many complications after the long-term use of bisphosphonates. The American Society for Bone and Mineral Research has officially excluded periprosthetic femoral fractures (PFFs) from the definition of atypical femoral fractures (AFFs). Several case reports found that PFFs can occur with characteristics similar to those of AFFs. The purpose of our study was to evaluate the proportion of atypical fractures among Vancouver type B1 fractures, and to determine the association between the long-term use of bisphosphonates and the occurrence of atypical periprosthetic femoral fractures (APFFs). Methods In this retrospective study, we reviewed 41 patients with Vancouver type B1 periprosthetic fractures between January 1, 2011 and December 31, 2018. We classified them into two groups, namely atypical and typical PFFs, based on the fracture morphology. We noted the proportion of atypical periprosthetic fractures among B1 fractures and identified risk factors. Results Among the 41 PFFs, 5 (13%) fractures were classified as atypical PFF based on the radiological characteristics. The longer duration of bisphosphonate use was probably the only independent risk factor that significantly increases the occurrence of APFF (p = 0.03, 0.08 (CI 0.008 – 0.16)). There were no significant differences in age, gender, body mass index, comorbidities, corticosteroid use, positioning of the femoral stem, the method of fixation (cemented or cementless) and time lapse from before the primary prosthesis implantation to the PFF in the development of atypical fracture type. Conclusions There seems to be a correlation between the long-term intake of bisphosphonates and the atypical periprosthetic fracture. Atypical femoral fracture can also occur in the periprosthetic form. Trial registration Study number: 22/2019-SZTE, http://www.klinikaikutatas.hu/hu/kutatasetika/jovahagyott-vizsgalatok-koezerdeku-adatai/category/25-jovahagyott-vizsgalatok-kozerdeku-adatai-rkeb-2019.html?download=985:22-2019.

scholarly journals Atypical Insufficiency Fractures Associated with Long-Term Bisphosphonate Therapy: 3 Case Reports

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Sandrine Malochet Guinamand
Keyword(s):  
Case Reports ◽  
Femoral Fractures ◽  
Bisphosphonate Therapy ◽  
Fracture Site ◽  
Atypical Fracture ◽  
Mineral Research ◽  
The Third ◽  
First Case ◽  
The Right

Atypical femoral fractures as defined by the American Society for Bone and Mineral Research (ASBMR) are linked with long-term bisphosphonate therapy. We report the cases of 3 patients treated with bisphosphonates, and presenting non femoral atypical fracture. Our first patient presented with a series of fractures after being treated with risedronate: the left tibia, bilateral tibial plateau successively, the left femoral and tibial metaphysis, the right tibia and calcaneus, the left talus, and the left talar dome. The second patient had been taking alendronate and presented with a spontaneous fracture of the spine of the left scapula. The third patient had been treated with alendronate and presented with a fracture of the upper right tibial diaphysis with an unusual oblique orientation. These fractures could be suggestive of bisphosphonate therapy failure or stress fractures. However, the number of fractures in our first case, the fracture site in the second and the fracture line orientation in the third brings to mind the hypothesis of atypical non femoral fractures associated with bisphosphonate therapy. We therefore suggest the possibility of a new type of atypical fracture in patients treated with bisphosphonates, and whose causal relationship with bisphosphonates is even more difficult to demonstrate.

scholarly journals Nontraumatic bilateral atypical femoral fractures associated with long-term alendronate therapy

2020 ◽  
Vol 9 (11) ◽  
pp. 1737
Author(s):  
Olayinka A. Ogundipe
Keyword(s):  
Femoral Fractures ◽  
Case Definition ◽  
Term Therapy ◽  
Caucasian Woman ◽  
X Rays ◽  
Medication History ◽  
Mineral Research ◽  
Atypical Femoral Fractures ◽  
Femur Fractures

Alendronate is a bisphosphonate commonly used in the treatment of post-menopausal and steroid-associated osteoporosis. Bisphosphonates have an evidence base for reducing the occurrence of typical osteoporotic fractures. However, there has been growing recognition of a correlation with the use of long-term therapy with bisphosphonates, and rare occurrence of atypical femoral fractures (AFFs). This report describes a 72-year-old caucasian woman presenting with evolving groin and thigh pains of two weeks duration. Plain X-rays noted features compatible with bilateral impending femoral subtrochanteric fractures. She had been taking oral alendronate 70mg weekly for ten consecutive years as treatment for osteoporosis. Based on the medication history, the absence of preceding trauma or a fall, and the presence of supportive radiological findings, the diagnosis was made of impending bilateral proximal femur fractures secondary to long-term bisphosphonate therapy. The alendronate was discontinued, and the patient managed with two planned successive surgeries involving the insertion of intertrochanteric antegrade nails (inter-TAN) to both femurs. Following a period of rehabilitation, she was successfully discharged home. Some pharmacokinetic and pharmacodynamic considerations of bisphosphonates are discussed. The write-up presents a brief literature review of AFFs. The index report is further reviewed in relation to the American society for bone and mineral research (ASBMR) task force’s recommended case definition of what constitutes AFFs. The discussion concludes with the application of two previously validated causality assessment systems (CAS). In this instance, both CAS indicated a ‘probable’ classification for the adverse drug reaction (ADR) to prolonged usage of oral alendronate.

A calcar collar is protective against early periprosthetic femoral fracture around cementless femoral components in primary total hip arthroplasty

2019 ◽  
Vol 101-B (7) ◽  
pp. 779-786 ◽  
Author(s):  
J. N. Lamb ◽  
J. Baetz ◽  
P. Messer-Hannemann ◽  
I. Adekanmbi ◽  
B. H. van Duren ◽  
...  
Keyword(s):  
Femoral Fracture ◽  
Periprosthetic Fracture ◽  
In Vitro Model ◽  
Femoral Stem ◽  
Periprosthetic Femoral Fracture ◽  
Total Hip ◽  
Modes Of Failure ◽  
Early Revision ◽  
Vitro Model

Aims The aim of this study was to estimate the 90-day risk of revision for periprosthetic femoral fracture associated with design features of cementless femoral stems, and to investigate the effect of a collar on this risk using a biomechanical in vitro model. Materials and Methods A total of 337 647 primary total hip arthroplasties (THAs) from the United Kingdom National Joint Registry (NJR) were included in a multivariable survival and regression analysis to identify the adjusted hazard of revision for periprosthetic fracture following primary THA using a cementless stem. The effect of a collar in cementless THA on this risk was evaluated in an in vitro model using paired fresh frozen cadaveric femora. Results The prevalence of early revision for periprosthetic fracture was 0.34% (1180/337 647) and 44.0% (520/1180) occurred within 90 days of surgery. Implant risk factors included: collarless stem, non-grit-blasted finish, and triple-tapered design. In the in vitro model, a medial calcar collar consistently improved the stability and resistance to fracture. Conclusion Analysis of features of stem design in registry data is a useful method of identifying implant characteristics that affect the risk of early periprosthetic fracture around a cementless femoral stem. A collar on the calcar reduced the risk of an early periprosthetic fracture and this was confirmed by biomechanical testing. This approach may be useful in the analysis of other uncommon modes of failure after THA. Cite this article: Bone Joint J 2019;101-B:779–786.

scholarly journals Atypical Femoral Fracture during Long-term Bisphosphonate Therapy: A Case Report

2012 ◽  
Vol 61 (4) ◽  
pp. 795-798
Author(s):  
Kenichi Seo ◽  
Shinji Tomari ◽  
Yasumasa Ito ◽  
Tatsuya Yufu ◽  
Takahiro Yasuhara ◽  
...  
Keyword(s):  
Case Report ◽  
Femoral Fracture ◽  
Bisphosphonate Therapy ◽  
Atypical Femoral Fracture

scholarly journals Midterm results of consecutive periprosthetic femoral fractures Vancouver type A and B

2016 ◽  
Vol 6 (3) ◽  
Author(s):  
Klemens Trieb ◽  
Rainer Fiala ◽  
Christian Briglauer
Keyword(s):  
Femoral Fractures ◽  
Type A ◽  
Periprosthetic Femoral Fracture ◽  
Type B ◽  
Single Center ◽  
Midterm Results ◽  
Periprosthetic Femoral Fractures ◽  
Multimorbid Patients ◽  
Lost To Follow Up

Surgical treatment of periprosthetic femoral fractures has a high complication and mortality rate of more than 10%. The aim of this study is to report the outcome of a consecutive single center patient group. Thirty-four consecutive patients (mean age 81.2+/-8.5 years, 14 male, 20 female) with a periprosthetic femoral fracture Vancouver type A (n=5) or type B (n=29) were followed-up after 43.2 months, none of the patients were lost to follow- up. Nineteen of the patients were treated through change of the stem and cerclage fixation, five by plates and ten by cerclage cables. One successfully treated infection was observed. No further complications have been reported peri- or postoperatively, therefore resulting in 2.9% overall complication rate. These results demonstrate that precisely selected revision surgery protocol following periprosthetic femoral fractures within elderly multimorbid patients may lead to beneficial outcomes at a low risk of complications.

Impaction Loads Resulting in Intraoperative Periprosthetic Femoral Fracture: A Finite Element Study

2014 ◽  
Vol 553 ◽  
pp. 299-304
Author(s):  
Caleb Christos Ioannidis ◽  
Danè Dabirrahmani ◽  
Qing Li ◽  
Zhong Pu Zhang ◽  
Jun Ning Chen ◽  
...  
Keyword(s):  
Finite Element ◽  
Extended Finite Element Method ◽  
Femoral Stem ◽  
Femoral Fractures ◽  
Patient Specific ◽  
Periprosthetic Femoral Fracture ◽  
Extended Finite Element ◽  
Bone Damage ◽  
Scan Data ◽  
And Gender

Intraoperative periprosthetic femoral fractures (IPPFF) occur in approximately 3-5% of all cementless total hip arthroplasty (THA) surgeries. This study aimed to identify the critical impaction load to cause an IPPFF during implant implementation. This critical load may be used as a guideline for surgeons as well as a parameter for the design of future surgical tools and procedures. This study concerned a single femur of a healthy 60 year old female with an anatomical femoral stem implant, thus the effects of patient specific variables (such as osteoporosis, amount of bone resorption, bone damage, implant geometry, age and gender) were not considered. The eXtended Finite Element Method (XFEM) was used to analyse the fracture. From CT scan data, a user-defined subroutine is used to assign heterogeneous isotropic material properties to the femur. It was computed that IPPFF would take place at an impaction load of 18.5 kN.

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