scholarly journals Risk factors influencing fracture characteristics in postoperative periprosthetic femoral fractures around cemented stems in total hip arthroplasty

2021 ◽  
Vol 2 (7) ◽  
pp. 466-475
Author(s):  
Sameer Jain ◽  
Jonathan Lamb ◽  
Oliver Townsend ◽  
Chloe E. H. Scott ◽  
Ben Kendrick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Fractures ◽  
Similar Proportion ◽  
Fracture Characteristics ◽  
Total Hip ◽  
Factors Influencing ◽  
Periprosthetic Femoral Fractures ◽  
Multiple Variables

Aims This study evaluates risk factors influencing fracture characteristics for postoperative periprosthetic femoral fractures (PFFs) around cemented stems in total hip arthroplasty. Methods Data were collected for PFF patients admitted to eight UK centres between 25 May 2006 and 1 March 2020. Radiographs were assessed for Unified Classification System (UCS) grade and AO/OTA type. Statistical comparisons investigated relationships by age, gender, and stem fixation philosophy (polished taper-slip (PTS) vs composite beam (CB)). The effect of multiple variables was estimated using multinomial logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Surgical treatment (revision vs fixation) was compared by UCS grade and AO/OTA type. Results A total of 584 cases were included. Median age was 79.1 years (interquartile range 72.0 to 86.0), 312 (53.6%) patients were female, and 495 (85.1%) stems were PTS. The commonest UCS grade was type B1 (278, 47.6%). The most common AO/OTA type was spiral (352, 60.3%). Metaphyseal split fractures occurred only with PTS stems with an incidence of 10.1%. Male sex was associated with a five-fold reduction in odds of a type C fracture (OR 0.22 (95% CI 0.12 to 0.41); p < 0.001) compared to a type B fracture. CB stems were associated with significantly increased odds of transverse fracture (OR 9.51 (95% CI 3.72 to 24.34); p < 0.001) and wedge fracture (OR 3.72 (95% CI 1.16 to 11.95); p = 0.027) compared to PTS stems. Both UCS grade and AO/OTA type differed significantly (p < 0.001 and p = 0.001, respectively) between the revision and fixation groups but a similar proportion of B1 fractures underwent revision compared to fixation (45.3% vs 50.6%). Conclusion The commonest fracture types are B1 and spiral fractures. PTS stems are exclusively associated with metaphyseal split fractures, but their incidence is low. Males have lower odds of UCS grade C fractures compared to females. CB stems have higher odds of bending type fractures (transverse and wedge) compared to PTS stems. There is considerable variation in practice when treating B1 fractures around cemented stems. Cite this article: Bone Jt Open 2021;2(7):466–475.

Risk factors for periprosthetic femoral fractures around total hip arthroplasty: a systematic review and meta‐analysis

2019 ◽  
Vol 90 (4) ◽  
pp. 441-447 ◽  
Author(s):  
Yi Deng ◽  
David Kieser ◽  
Michael Wyatt ◽  
Mark Stringer ◽  
Christopher Frampton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Femoral Fractures ◽  
Total Hip ◽  
Periprosthetic Femoral Fractures

scholarly journals Patient and implant survival following intraoperative periprosthetic femoral fractures during primary total hip arthroplasty

2019 ◽  
Vol 101-B (10) ◽  
pp. 1199-1208 ◽  
Author(s):  
Jonathan N. Lamb ◽  
Gulraj S. Matharu ◽  
Anthony Redmond ◽  
Andrew Judge ◽  
Robert M. West ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Cox Regression ◽  
Patient Survival ◽  
Femoral Fractures ◽  
Trochanteric Fracture ◽  
Total Hip ◽  
Periprosthetic Femoral Fractures ◽  
Primary Total Hip Arthroplasty

Aims We compared implant and patient survival following intraoperative periprosthetic femoral fractures (IOPFFs) during primary total hip arthroplasty (THA) with matched controls. Patients and Methods This retrospective cohort study compared 4831 hips with IOPFF and 48 154 propensity score matched primary THAs without IOPFF implanted between 2004 and 2016, which had been recorded on a national joint registry. Implant and patient survival rates were compared between groups using Cox regression. Results Ten-year stem survival was worse in the IOPFF group (p < 0.001). Risk of revision for aseptic loosening increased 7.2-fold following shaft fracture and almost 2.8-fold after trochanteric fracture (p < 0.001). Risk of periprosthetic fracture of the femur revision increased 4.3-fold following calcar-crack and 3.6-fold after trochanteric fracture (p < 0.01). Risk of instability revision was 3.6-fold after trochanteric fracture and 2.4-fold after calcar crack (p < 0.001). Risk of 90-day mortality following IOPFF without revision was 1.7-fold and 4.0-fold after IOPFF with early revision surgery versus uncomplicated THA (p < 0.001). Conclusion IOPFF increases risk of stem revision and mortality up to ten years following surgery. The risk of revision depends on IOPFF subtype and mortality risk increases with subsequent revision surgery. Surgeons should carefully diagnose and treat IOPFF to minimize fracture progression and implant failure. Cite this article: Bone Joint J 2019;101-B:1199–1208

scholarly journals Cement-in-cement stem revision for Vancouver type B periprosthetic femoral fractures after total hip arthroplasty

2009 ◽  
Vol 80 (5) ◽  
pp. 548-552 ◽  
Author(s):  
Toby W Briant-Evans ◽  
Darmaraja Veeramootoo ◽  
Eleftherios Tsiridis ◽  
Matthew J Hubble
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Fractures ◽  
Type B ◽  
Total Hip ◽  
Stem Revision ◽  
Periprosthetic Femoral Fractures

Periprosthetic Femoral Fractures in Total Hip Arthroplasty

2014 ◽  
Vol 24 (6) ◽  
pp. 556-567 ◽  
Author(s):  
Nicholas E. Ohly ◽  
Michael R. Whitehouse ◽  
Clive P. Duncan
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Fractures ◽  
Total Hip ◽  
Periprosthetic Femoral Fractures

scholarly journals Intraoperative periprosthetic femoral fractures at total hip arthroplasty. Review of classifications and treatment techniques

2019 ◽  
Vol 26 (2) ◽  
pp. 67-72
Author(s):  
E. V Polevoy ◽  
N. V Zagorodniy ◽  
S. V Kagramanov ◽  
G. A Chragyan ◽  
O. A Aleksanyan
Keyword(s):  
Surgical Treatment ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Fractures ◽  
Treatment Technique ◽  
Total Hip ◽  
Treatment Techniques ◽  
Periprosthetic Femoral Fractures ◽  
Classification And Treatment

The review covers the problem of intraoperative periprosthetic femoral fractures at total hip arthroplasty including the causes, classification and treatment techniques. This complication may occur at any step of the intervention, may differ by localization and pattern. All these will determine the preferable surgical treatment technique.

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