Factors influencing periprosthetic femoral fracture risk

Aims Periprosthetic femoral fractures (PPF) are a serious complication of total hip arthroplasty (THA) and are becoming an increasingly common indication for revision arthroplasty with the ageing population. This study aimed to identify potential risk factors for PPF based on an analysis of registry data. Methods Cases recorded with PPF as the primary indication for revision arthroplasty in the German Arthroplasty Registry (Endoprothesenregister Deutschland (EPRD)), as well as those classified as having a PPF according to the International Classification of Diseases (ICD) codes in patients’ insurance records were identified from the complete datasets of 249,639 registered primary hip arthroplasties in the EPRD and included in the analysis. Results The incidence of PPFs was higher (24.6%; 1,483) than reported in EPRD annual reports listing PPF as the main reason for revision (10.9%; 654). The majority of fractures occurred intraoperatively and were directly related to the implantation process. Patients who were elderly, female, or had comorbidities were at higher risk of PPFs (p < 0.001). German hospitals with a surgical volume of < 300 primary procedures per year had a higher rate of PPFs (p < 0.001). The use of cemented and collared prostheses had a lower fracture risk PPF compared to uncemented and collarless components, respectively (both p < 0.001). Collared prostheses reduced the risk of PPF irrespective of the fixation method and hospital’s surgical volume. Conclusion The high proportion of intraoperative fractures emphasises the need to improve surgeon training and surgical technique. Registry data should be interpreted with caution because of potential differences in coding standards between institutions. Cite this article: Bone Joint J 2021;103-B(4):650–658.

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Mortality, Risk Factors and Risk Assessment after Periprosthetic Femoral Fractures—A Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10194324 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4324

Author(s):

Thaqif El Khassawna ◽

Gero Knapp ◽

Nadja Scheibler ◽

Deeksha Malhan ◽

Nike Walter ◽

...

Keyword(s):

Risk Assessment ◽

Descriptive Analysis ◽

Revision Arthroplasty ◽

Femoral Fractures ◽

Postoperative Outcome ◽

Womac Score ◽

Periprosthetic Femoral Fracture ◽

Delayed Surgery ◽

Significant Difference ◽

American Society

Periprosthetic femoral fracture (PFF) is a devastating complication. Here, the authors aimed to determine the influence of the timing of surgery as a risk factor for mortality and poor postoperative outcome in patients suffering from PFF. A retrospective descriptive analysis of patients treated for PFF between January 2010 and March 2018 was performed. In addition to patient and treatment characteristics, we assessed mortality rates and postoperative functional outcome by using the Harris Hip and WOMAC score. One-year mortality after PFF was 10.7%. Delayed surgery after 48 h did not negatively influence mortality after PFF. The postoperative hospital stay did not influence the mortality rate, nor did it correlate with medical scores of comorbidities, general health or functionalities. Cementation of stem correlated negatively with the WOMAC score. Deceased patients had a higher Charlson Comorbidity Index (CCI) score, while American society of Anaesthesiologists (ASA) scores did not show a significant difference. There were no differences between ORIF and revision arthroplasty. In conclusion, delayed surgery after 48 h does not negatively influence mortality after PFF. The CCI seems to be a suitable tool to assess patients’ risk for increased mortality after PFF, while the usually used ASA score is not able to achieve a relevant risk assessment.

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The impact of stem fixation method on Vancouver Type B1 periprosthetic femoral fracture management

SICOT-J ◽

10.1051/sicotj/2021064 ◽

2022 ◽

Vol 8 ◽

pp. 1

Author(s):

Katherine Wang ◽

Eustathios Kenanidis ◽

Zakareya Gamie ◽

Khurram Suleman ◽

Mark Miodownik ◽

...

Keyword(s):

Strain Distribution ◽

Hip Prosthesis ◽

Mechanical Strain ◽

Femoral Fractures ◽

Fixation Method ◽

Periprosthetic Femoral Fracture ◽

Periprosthetic Femoral Fractures ◽

Fracture Management ◽

The Impact ◽

Laboratory Models

Introduction: Our understanding of the impact of the stem fixation method in total hip arthroplasty (THA) on the subsequent management of periprosthetic femoral fractures (PFF) is still limited. This study aimed to investigate and quantify the effect of the stem fixation method, i.e., cemented vs. uncemented THA, on the management of Vancouver Type B1 periprosthetic femoral fractures with the same plate. Methods: Eight laboratory models of synthetic femora were divided into two groups and implanted with either a cemented or uncemented hip prosthesis. The overall stiffness and strain distribution were measured under an anatomical one-legged stance. All eight specimens underwent an osteotomy to simulate Vancouver type B1 PFF’s. Fractures were then fixed using the same extramedullary plate and screws. The same measurements and fracture movement were taken under the same loading conditions. Results: Highlighted that the uncemented THA and PFF fixation constructs had a lower overall stiffness. Subsequently, the mechanical strain on the fracture plate for the uncemented construct was higher compared to the cemented constructs. Conclusion: PFF fixation of a Vancouver type B1 fracture using a plate may have a higher risk of failure in uncemented THAs.

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Periprosthetic femoral fracture type and location are influenced by the presence of an ipsilateral knee arthroplasty implant: A case-control study of 84 interprosthetic femoral fractures

Injury ◽

10.1016/j.injury.2021.11.047 ◽

2021 ◽

Author(s):

Oliver Townsend ◽

Sameer Jain ◽

Jonathan N Lamb ◽

Chloe E H Scott ◽

Douglas G Dunlop ◽

...

Keyword(s):

Knee Arthroplasty ◽

Femoral Fracture ◽

Case Control Study ◽

Femoral Fractures ◽

Case Control ◽

Periprosthetic Femoral Fracture ◽

Fracture Type ◽

Control Study

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Prediction of a new fracture after a wrist fracture – a five year follow up

10.21203/rs.2.22334/v1 ◽

2020 ◽

Author(s):

Eva Ekvall Hansson ◽

Leif E Dahlberg ◽

Måns Magnusson ◽

Anders Beckman

Keyword(s):

Fracture Risk ◽

Assessment Tool ◽

Postural Sway ◽

Force Plate ◽

Wrist Fracture ◽

Local Health ◽

Ageing Population ◽

Self Rated Health ◽

Future Fracture

Abstract Background Falls and ensuing fractures are major challenges in our ageing population. The aim of this study was to study if clinical balance measures, function of the inner ear, self-rated health or fracture risk assessed by FRAX ® could predict future admission to hospital because of a fracture among a group of older persons with previous wrist fracture. Methods This was a longitudinal study with a 5-year follow-up. Searches in the local health authority’s patient administrative system (PAS) were performed 5 years after inclusion and baseline measurements were taken. Information was extracted about whether participants had been treated for a fracture or hospitalized other reasons during the 5-year period. Persons, 50 years and above, with previous wrist fracture (n=83). Five different clinical balance measures was assessed, postural sway was assessed by means of a force plate, vestibular asymmetry was assessed with the head- shake test, self-rated health by EuroQol 5 Dimension visual analogue scale and risk of future fracture by the Fracture Risk Assessment Tool (FRAX ® ). Age and body mass index was also used in the risk analysis. Results Age was associated with risk of future fracture, OR 1,06 (95% CI 1,01-1,12). The ability to stand on one leg with eyes open correlated significantly with future fracture (p=0.011) and so did FRAXosteo, however on the limits of significance (p=0.052). Conclusion This follow-up study showed that the one-leg standing time-test was a stronger predictor for future facture within five-years after a wrist fracture than FRAX not including a measure of balance.

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Atypical periprosthetic femoral fracture associated with long-term bisphosphonate therapy

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01941-x ◽

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.

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The epidemiology of osteoporosis

British Medical Bulletin ◽

10.1093/bmb/ldaa005 ◽

2020 ◽

Author(s):

Michael A Clynes ◽

Nicholas C Harvey ◽

Elizabeth M Curtis ◽

Nicholas R Fuggle ◽

Elaine M Dennison ◽

...

Keyword(s):

Fracture Risk ◽

Economic Burden ◽

Osteoporotic Fractures ◽

Fragility Fractures ◽

Ageing Population ◽

Mineral Density ◽

High Fracture ◽

Osteoporosis Screening ◽

The Usa ◽

Receive Treatment

Abstract Introduction With a worldwide ageing population, the importance of the prevention and management of osteoporotic fragility fractures is increasing over time. In this review, we discuss in detail the epidemiology of fragility fractures, how this is shaped by pharmacological interventions and how novel screening programmes can reduce the clinical and economic burden of osteoporotic fractures. Sources of data PubMed and Google Scholar were searched using various combinations of the keywords ‘osteoporosis’, ‘epidemiology’, ‘fracture’, ‘screening’, `FRAX’ and ‘SCOOP’. Areas of agreement The economic burden of osteoporosis-related fracture is significant, costing approximately $17.9 and £4 billion per annum in the USA and UK. Areas of controversy Risk calculators such as the web-based FRAX® algorithm have enabled assessment of an individual’s fracture risk using clinical risk factors, with only partial consideration of bone mineral density (BMD). Growing points As with all new interventions, we await the results of long-term use of osteoporosis screening algorithms and how these can be refined and incorporated into clinical practice. Areas timely for developing research Despite advances in osteoporosis screening, a minority of men and women at high fracture risk worldwide receive treatment. The economic and societal burden caused by osteoporosis is a clear motivation for improving the screening and management of osteoporosis worldwide.

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

Clinics and Practice ◽

10.4081/cp.2016.871 ◽

2016 ◽

Vol 6 (3) ◽

Cited By ~ 4

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.

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Femoral Perforation during Cement Removal in Revision Hip Arthroplasty

Hip International ◽

10.1177/112070009700700401 ◽

1997 ◽

Vol 7 (4) ◽

pp. 153-157 ◽

Cited By ~ 4

Author(s):

P.R. Williams ◽

M.V.S. Maheson

Keyword(s):

Bone Cement ◽

Femoral Fracture ◽

High Speed ◽

Revision Arthroplasty ◽

Periprosthetic Femoral Fracture ◽

Acrylic Bone Cement ◽

Femoral Revision ◽

Cemented Stem ◽

High Speed Burr ◽

Hip Arthroplasties

Eighty two cemented femoral revision hip arthroplasties were reviewed to assess the incidence of intraoperative perforation of the femur and subsequent periprosthetic fracture using a high speed pneumatic burr for the removal of acrylic bone cement with an extensile exposure. There was one case of intraoperative femoral perforation; this patient did not go onto fracture postoperatively. There were no cases of intraoperative femoral fracture. There were 3 cases of periprosthetic femoral fracture all of which occurred more than 12 months after their impaction grafted femoral revision arthroplasty using a standard length cemented stem. The pneumatic high speed burr was extremely effective in the removal of acrylic bone cement in femoral revision arthroplasty. The incidence of subsequent femoral fracture in the impaction grafted revised population was low and did not appear to be related to intraoperative femoral perforation.

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

Applied Mechanics and Materials ◽

10.4028/www.scientific.net/amm.553.299 ◽

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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