scholarly journals OUTCOME OF PERIPROSTHETIC FEMORAL FRACTURES IN HIP ARTHROPLASTY

2018 ◽  
Vol 24 (3) ◽  
pp. 34-44
Author(s):  
A. A. Korytkin ◽  
Y. M. El Moudni ◽  
K. A. Kovaldov ◽  
Y. S. Novikova ◽  
B. Yu. Belousov
Keyword(s):  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Femoral Fractures ◽  
Periprosthetic Fractures ◽  
Greater Trochanter ◽  
Periprosthetic Femoral Fractures ◽  
Large Joint ◽  
Medical Histories ◽  
Distal Fixation

Periprosthetic fractures are one of the main reasons for revision surgery according to the data of large joint replacement registers. Treatment of patients with periprosthetic fractures is associated with a big number of complications and still keeps its relevance. Purposeof the study is to evaluate treatment outcome of patients with periprosthetic femoral fractures in hipreplacement. Material and Methods.The authors performed a retrospective analysis of medical histories of 76 patients whounderwent treatment of periprosthetic femoral fractures. The patients were divided into groups by the Unified Classification System (UCS). Follow up period was from 6 to 124 months (mean of 34.90±28.81). Results.3 cases (3.9%) of periprosthetic femoral fractures were the complications after primary hip arthroplastyand occurred intraoperatively, 75 cases (96.1%) were complications after revision surgery; 56 cases (71.8%) were reported with uncemented and 22 cases (28.2%) with cemented femoral components. In 30 cases (38.5%) fractures had a iatrogenic nature and occurred intraoperatively, in 48 cases (61.5%) — occurred due to high- and low energy trauma. Type B fractures were observed most often — in 53 cases (68%). Conservative treatment, fixation by cerclage or by plate and screws has proven to be the least effective operative options. In the group of patients with extended osteotomy of the greater trochanter the healing was achieved in 90.5% of cases, while in the group without osteotomy — in 75% of cases. Low healing rate of periprosthetic fractures was observed for A and B1 type fractures (65% and 66.7% respectively). Follow up of patients with B2, B3 and C type fractures demonstrated consolidation in more than 80% of cases. Various complications were reported in 17 cases (21.8%). Conclusion.Effective treatment of patients with periprosthetic femoral fractures was associated with extendedosteotomy of the greater trochanter (γ = 0.51;p= 0.032), absence of complications in postoperative period (R= 0.55;p= 0.00001), B2, B3 and C fracture types (γ= 0.40;p= 0.02) and use of revision uncemented femoral components withdistal fixation (γ = 0.35;p= 0.018). In the authors opinion use of sutures or cerclage wires are not effective in cases of trochanteric fractures and stable femoral components; it would be preferable to perform internal fixation by a plate with hooks such as Dall-Miles. In case of doubts in regard of stem stability the revision should rather stipulate use of uncemented femoral components, in particular long stems with distal fixation.

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 RESULTS OF TREATMENT OF PERIPROSTHETIC FEMORAL FRACTURES AFTER TOTAL HIP ARTHROPLASTY

2013 ◽  
Vol 56 (2) ◽  
pp. 67-72 ◽  
Author(s):  
Martin Korbel ◽  
Pavel Šponer ◽  
Tomáš Kučera ◽  
Egon Procházka ◽  
Tomáš Proček
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Fractures ◽  
Periprosthetic Fractures ◽  
Radiographic Images ◽  
Fair Result ◽  
Total Hip ◽  
Results Of Treatment ◽  
Periprosthetic Femoral Fractures ◽  
The Stability

Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12–45 months). For the clinical evaluation, we used modified Merle d’Aubigné scoring system.In group of Vancouver A fractures, 3 patients were treated with a mean score of 15.7 points (good result). We recorded a mean score of 14.2 points (fair result) in 6 patients with Vancouver B1 fractures, 12.4 points (fair result) in 24 patients with Vancouver B2 fractures and 12.7 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16.2 points (good result) in 7 patients.Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable. If in doubt, checking the stability of the prosthesis fixation during surgery should be performed.

scholarly journals Osteosynthesis and outcomes of traumatic periprosthetic femoral fractures after total hip arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Ali Taha ◽  
ElZaher Hassan ElZaher ◽  
Ibrahim ElGanzoury ◽  
Mostafa Ashoub ◽  
Amr Khairy
Keyword(s):  
Total Hip Arthroplasty ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
Open Reduction ◽  
Femoral Fractures ◽  
Harris Hip Score ◽  
Total Hip ◽  
Periprosthetic Femoral Fractures ◽  
The Mean

Abstract Purpose The aim of this retrospective study was to investigate the treatment of traumatic periprosthetic femoral fractures with open reduction and internal fixation. The outcomes with the use of the surgical techniques were also reported. Methods Between September 2017 and September 2019, 25 patients with traumatic periprosthetic femoral fractures were managed by open reduction and internal fixation in Ain Shams University Hospital, Egypt. The fixation methods were selected based on the surgeon’s preference. Outcomes were assessed using the Harris Hip Score, visual analogue score (VAS) for pain, and EuroQol 5 Dimensions – 5 Level (EQ5D-5L) prior to and after surgery. Patients were regularly followed up for one year. A P value < 0.05 was considered to be statistically significant. Results The mean age at surgery was 77 years (range, 51 to 95 years), 64% (n = 16) were females. According to the Vancouver classification, there were 1 type AG, 15 type B1, and 9 type C fractures. Postoperative complications included wound site infection (n = 2) and non-union (n = 1). The mean pre-trauma Harris Hip Score was 77.44 ± 8.63 (range, 65 to 90), and the mean Harris Hip Score collected at the final follow-up was 72.47 ± 8.85 (range, 60 to 86) (P < 0.05). The mean pre-trauma VAS was 2.20 ± 1.21 (range, 0 to 4), and the mean VAS recorded at the final follow-up was 3.00 ± 1.41 (range, 0 to 5) (P < 0.05). According to the EQ5D-DL assessed at the final follow-up, no patient felt that their daily life and activities became more problematic. Conclusion This study provided added validation of the current management of periprosthetic femoral fractures after total hip arthroplasty. Using the proper fixation and implant can achieve a reliable fixation and good functional recovery. Level of evidence IVa

Outcomes of Vancouver B2 and B3 periprosthetic femoral fractures after total hip arthroplasty in elderly patients

2018 ◽  
Vol 29 (2) ◽  
pp. 184-190 ◽  
Author(s):  
Jesús Moreta ◽  
Iker Uriarte ◽  
Amaia Ormaza ◽  
Javier Mosquera ◽  
Kattalin Iza ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Fracture Healing ◽  
Femoral Fractures ◽  
Functional Results ◽  
High Rate ◽  
Periprosthetic Fractures ◽  
Harris Hip Score ◽  
Periprosthetic Femoral Fractures ◽  
The Mean

Introduction: The objective was to evaluate clinical and radiological outcomes of Vancouver B2 and B3 periprosthetic femoral fractures in patients older than 65 years treated at our institution from 2000 to 2014. We compared the most common methods of fixation: a modular tapered rectangular titanium stem versus a monoblock tapered stem. Methods: A retrospective review was performed with a minimum follow-up time of 2 years. Patient mobility in the period prior to the fracture and after fracture healing and functional results was assessed according to the Harris Hip Score. Results: A total of 43 Vancouver B2 and B3 periprosthetic fractures fulfilled the inclusion criteria (31 type B2 and 13 type B3). The mean age was 78 years old (66–88 years). The mean follow-up time was 5 years (range 2–12 years). A Wagner stem was used in 19 patients and a modular rectangular stem was implanted in 24 patients. Although fracture union was achieved in 93% of the cases, the mean Harris Hip Score was 73 (34–87) and 41.9% of the patients did not return to their previous ambulatory levels ( p = 0.0049). Dislocation was the most common complication (16.3%). We have found association ( p = 0.07) between subsidence with a mean of 4.14 mm and dislocation. No difference was observed between B2 and B3 fractures or between modular and monoblock stems. Discussion: Although we reported good results of fracture healing, there were functional impairment and a high rate of complications, especially dislocation, in Vancouver B2 and B3 periprosthetic fractures in elderly patients.

scholarly journals Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 517
Author(s):  
Christopher Bliemel ◽  
Katherine Rascher ◽  
Tom Knauf ◽  
Juliana Hack ◽  
Daphne Eschbach ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Femoral Fractures ◽  
Geriatric Trauma ◽  
Outcome Parameters ◽  
Periprosthetic Femoral Fractures ◽  
Trauma Society ◽  
Eq5d Index ◽  
Early Surgical Treatment

Background and Objectives: Appropriate timing of surgery for periprosthetic femoral fractures (PFFs) in geriatric patients remains unclear. Data from a large international geriatric trauma register were analyzed to examine the outcome of patients with PFF with respect to the timing of surgical stabilization. Materials and Methods: The Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) was analyzed. Patients treated surgically for PFF were included in this analysis. As outcome parameters, in-house mortality rate and mortality at the 120-day follow-up as well as mobility, the EQ5D index score and reoperation rate were analyzed in relation to early (<48 h) or delayed (≥48 h) surgical stabilization. Results: A total of 1178 datasets met the inclusion criteria; 665 fractures were treated with osteosynthesis (56.4%), and 513 fractures were treated by implant change (43.5%). In contrast to the osteosynthesis group, the group with implant changes underwent delayed surgical treatment more often. Multivariate logistic regression analysis of mortality rate (p = 0.310), walking ability (p = 0.239) and EQ5D index after seven days (p = 0.812) revealed no significant differences between early (<48 h) and delayed (≥48 h) surgical stabilization. These items remained insignificant at the follow-up as well. However, the odds of requiring a reoperation within 120 days were significantly higher for delayed surgical treatment (OR: 1.86; p = 0.003). Conclusions: Early surgical treatment did not lead to decreased mortality rates in the acute phase or in the midterm. Except for the rate of reoperation, all other outcome parameters remained unaffected. Nevertheless, for most patients, early surgical treatment should be the goal, so as to achieve early mobilization and avoid secondary nonsurgical complications. If early stabilization is not possible, it can be assumed that orthogeriatric co-management will help protect these patients from further harm.

scholarly journals Treatment of Periprosthetic Femoral Fractures Following Hip Arthroplasty

Hip & Pelvis ◽  
2018 ◽  
Vol 30 (2) ◽  
pp. 78 ◽  
Author(s):  
Joong-Myung Lee ◽  
Tae-sup Kim ◽  
Tae-ho Kim
Keyword(s):  
Hip Arthroplasty ◽  
Femoral Fractures ◽  
Periprosthetic Femoral Fractures

scholarly journals Revision Rates After Surgical Treatment for Femoral Neck Fractures: Results of 2-Year Follow-up

Medicina ◽  
2013 ◽  
Vol 49 (3) ◽  
pp. 22
Author(s):  
Jaunius Kurtinaitis ◽  
Narūnas Porvaneckas ◽  
Giedrius Kvederas ◽  
Tomas Butėnas ◽  
Valentinas Uvarovas
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Femoral Neck Fractures ◽  
Total Hip ◽  
Significant Difference ◽  
Surgery Rates

Background and Objective. Intracapsular fractures of the femoral neck account for a major share of fractures in the elderly. Open reduction and internal fixation has been shown to have a higher rate of revision surgery than arthroplasty. The aim of this study was to assess and compare the rates of revision surgery performed after internal fixation and primary total hip arthroplasty. Material and Methods. Between 2004 and 2006, 681 intracapsular femoral neck fractures in 679 consecutive patients were treated with internal fixation or total hip arthroplasty at our institution. Revision surgery rates were evaluated at 1-, 3-, 6-, 12-, and 24-month follow-up. Results. There was no significant difference in the ratio of internal fixation to total hip arthroplasty during 2004–2006 (P=0.31). The mean rate of total hip arthroplasty was 19.1% with a lower rate being among patients younger than 60 years. Revision surgery rates at the 2-year followup were higher in the internal fixation group compared with total hip arthroplasty group (28.9% vs. 7.0%, P<0.001). Patients who underwent internal fixation were at a 4-fold greater risk of having revision surgery at the 2-year follow-up than those who underwent total hip arthroplasty (odds ratio, 4.11; 95% CI, 1.95–8.65; P<0.001). Age was a significant risk factor for revision surgery after total hip arthroplasty (hazard ratio, 0.93; 95% CI, 0.87–0.98; P=0.02), but not significant after the internal fixation (P=0.86). Conclusions. Higher revision surgery rates after internal fixation favors arthroplasty as a primary choice of treatment for the femoral neck fractures.

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.

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