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Yun C, Qian W, Zhang J, Zhang W, Lv J. Biomechanics of PHILOS plates in Vancouver B1 periprosthetic femoral fracture. Front Bioeng Biotechnol 2023; 11:1282128. [PMID: 38047287 PMCID: PMC10690819 DOI: 10.3389/fbioe.2023.1282128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023] Open
Abstract
Objective: To investigate the clinical efficacy of PHILOS plates in the treatment of Vancouver B1 periprosthetic femoral fracture (PFF) and to validate its biomechanical reliability via finite element analysis and mechanical testing on the Synbone femoral models. Methods: Ten males and eight females with Vancouver B1 PFF who underwent PHILOS plate fixation between September 2017 and January 2022 were selected. The average age was 72.61 ± 8.19 years, with a range of 57-86 years old. X-ray films were taken to assess the fracture healing situation around the femoral prosthesis as well as the position of the PHILOS plates and femoral prosthesis. Two different plates (the PHILOS plate and the Cable GTR plate) were used for fixation, and the differences in biomechanical stability of the two fixation methods were compared using finite element analysis and mechanical testing on the Synbone femoral models to validate the biomechanical dependability of the PHILOS plate. Results: All 18 cases were followed for at least 1 year, as a result. The average period of follow-up was 17 months, ranging from 12 to 36 months. At the most recent follow-up, Harris scores for the hip joints of patients ranged from 82 to 89, with an average score of 86. The X-rays revealed that all fractures surrounding the femoral prosthesis had healed and that there was no looseness in the femoral prosthesis. None of the PHILOS license plates had expired. All patients were able to perform full-load walking, and pain and claudication in affected limbs were significantly reduced. Finite element analysis and mechanical testing of the Synbone femoral model revealed that the fixation effect of the PHILOS group was superior to that of the Cable group; consequently, PHILOS plates can be used to effectively fix fractures around the proximal femoral prosthesis. Conclusion: PHILOS plates are initially used in the treatment of Vancouver B1 PFF, which may be a good choice due to their simpler operation, lower medical costs, and satisfactory clinical efficacy.
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Affiliation(s)
- Changjun Yun
- Departmeut of Orthopaedics, The Affiliated Wujin Hospital of Jiangsu University, Changzhou, China
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Wenjie Qian
- Departmeut of Orthopaedics, The Affiliated Wujin Hospital of Jiangsu University, Changzhou, China
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Jie Zhang
- Departmeut of Orthopaedics, The Affiliated Wujin Hospital of Jiangsu University, Changzhou, China
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Wen Zhang
- Orthopedic Institute, Soochow University, Suzhou, China
| | - Jinpeng Lv
- School of Pharmacy, Changzhou University, Changzhou, China
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Kubik JF, Bornes TD, Gausden EB, Klinger CE, Wellman DS, Helfet DL. Surgical outcomes of dual-plate fixation for periprosthetic femur fractures around a stable hip arthroplasty stem. Arch Orthop Trauma Surg 2022; 142:3605-3611. [PMID: 34003368 DOI: 10.1007/s00402-021-03950-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The incidence of periprosthetic femur fractures is increasing. Multiple treatment methods exist to treat fractures surrounding stable hip arthroplasty implants including locking plate fixation, cable fixation, allograft augmentation, and revision arthroplasty. No consensus regarding optimal treatment has been reached, and significant complications remain. Recently, biomechanical studies have demonstrated the benefits of orthogonal dual-plate fixation, but little clinical data exist. The purpose of the current study was to investigate the clinical and radiographic outcomes of dual-plated periprosthetic femur fractures around stable hip stems. MATERIALS AND METHODS Patients with periprosthetic femur fractures following hip arthroplasty with a stable femoral stem treated with dual-plate fixation were identified through chart review at a single institution. Fracture classification, fixation characteristics, radiographic outcomes, clinical outcomes and complications including re-operation were recorded. RESULTS Over a 12-year period, 31 patients (mean age 77 years at surgery, range 48-94) underwent dual plating by three traumatologists for implant-stable periprosthetic femur fractures surrounding a hip arthroplasty stem. There were 27 Vancouver B1-type and 9 inter-prosthetic fractures. Average follow-up was 2 years. Of the 26 patients with minimum 6-month follow-up, 24 (92%) united after index surgery (mean time to union 6.0 months, range 1.5-14.0). Mean time to full weight-bearing post-operatively was 2.6 months (range 1.5-4.0 months). Two patients required secondary surgery to address nonunion. CONCLUSIONS Dual-plating achieved high union rates with an acceptable complication profile for the treatment of periprosthetic femur fractures surrounding a stable hip arthroplasty stem. Our preferred fixation construct involves a lateral plate spanning the entire femur secured with non-locking bicortical screws supplemented with an anteriorly based reconstruction plate. Additional prospective research is required to confirm the results of this study.
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Affiliation(s)
- Jeremy F Kubik
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Troy D Bornes
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Elizabeth B Gausden
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Craig E Klinger
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - David S Wellman
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - David L Helfet
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
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Cementless, modular, titanium stem in Vancouver B2 and B3 periprosthetic femoral fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1133-1139. [PMID: 35434746 DOI: 10.1007/s00590-022-03267-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The periprosthetic femoral fracture (PFF) is a serious complication after primary total hip arthroplasty. We conducted a retrospective study to determine whether the PRIUS® system presented similar survival to other existing implants for the treatment of Vancouver B2 or B3 PFFs. Bone consolidation rate, functional results and complications were analysed. METHOD This is a bi-centric retrospective study between 2012 and 2017 including 39 patients with (B2/B3) PFFs treated by senior surgeons using a PRIUS® femoral implant. Implant survival, radiological outcome (fracture healing) and clinical scores (Oxford-OHS, Harris Hip Score-HHS, Postel Merle d'Aubigné-PMA, Devane and Charnley) were analysed. 10 patients had died before data collection and 5 patients were lost to follow-up. A total of 21 patients were able to undergo a clinical and radiological evaluation. The mean follow-up period was 3 years. RESULTS The 3-year PRIUS® stem survival rate was 88.6% [95% CI, 77.2-100]. The consolidation rate was 81% (17/21). The rate of satisfied or very satisfied patients was 85.6% (18/21). Regarding the Devane score, activity level was maintained in 70.6% of cases (12/17) and decreased in 29.4% of cases (5/17), the Charnley score was stable in 94% of cases (16/17) and decreased in 6% of cases (1/17). The mean Oxford score was 28.8/48 (9.3; 16-48), the mean HHS was 67/100 (16.4; 46-91) and the mean PMA score was 12.6/18 (4.5; 2-18). CONCLUSION The results in terms of survival rate and bone consolidation are comparable to other literature series. The PRIUS® System can be added to the surgical arsenal in the treatment of (B2/B3) PFF, subject to confirmation of these results in the longer term.
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Kösters C, den Toom D, Märdian S, Roßlenbroich S, Metzlaff S, Daniilidis K, Everding J. LOQTEQ ® VA Periprosthetic Plate-A New Concept for Bicortical Screw Fixation in Periprosthetic Fractures: A Technical Note. J Clin Med 2022; 11:jcm11051184. [PMID: 35268275 PMCID: PMC8911225 DOI: 10.3390/jcm11051184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Internal fixation using angle stable plates is the treatment standard in periprosthetic fractures around stable implants. To provide instant postoperative full weight-bearing, bicortical screw fixation is advisable but often surgically demanding. This work presents the first clinical results of the LOQTEQ® VA Periprosthetic Plate (aap Implantate AG, Berlin, Germany), a new plate system to simplify screw placement around implants. This plate system uses insertable hinges that allow for variable angle screw anchorage. Data of 26 patients with a mean age of 80 years and a mean follow-up of 13.9 months were retrospectively collected. Patients were clinically and radiologically examined. Bony union was achieved in 14 out of 15 patients with no signs of non-union or implant loosening. One patient, however, presented with implant failure. Clinical scores demonstrated acceptable results. Since the hinge plates are easy to apply, the first results are promising.
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Affiliation(s)
- Clemens Kösters
- Klinik für Orthopädie, Unfall-und Handchirurgie, Maria-Josef-Hospital Greven, 48268 Greven, Germany;
- Correspondence: ; Tel.: +49-2571-502-12001
| | - Daniel den Toom
- Klinik für Orthopädie, Unfall-und Handchirurgie, Maria-Josef-Hospital Greven, 48268 Greven, Germany;
| | - Sven Märdian
- Centrum für Muskuloskelettale Chirurgie, Charité Berlin, 13353 Berlin, Germany;
| | - Steffen Roßlenbroich
- Klinik für Unfall-, Hand-und Wiederherstellungschirurgie, Universitätsklinikum Münster, 48149 Münster, Germany; (S.R.); (J.E.)
| | - Sebastian Metzlaff
- Klinik für Orthopädie und Unfallchirurgie, St. Joseph Krankenhaus Berlin, 12101 Berlin, Germany;
| | | | - Jens Everding
- Klinik für Unfall-, Hand-und Wiederherstellungschirurgie, Universitätsklinikum Münster, 48149 Münster, Germany; (S.R.); (J.E.)
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Assessment of morbidity and mortality after periprosthetic hip fracture. Influence of Vancouver stage in a retrospective single-centre study of 88 patients. Orthop Traumatol Surg Res 2022; 108:102985. [PMID: 34116235 DOI: 10.1016/j.otsr.2021.102985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/22/2020] [Accepted: 11/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Peri-prosthetic hip fractures (PPHFs) are serious complications whose treatment is generally difficult due to their predominance in elderly patients with bone frailty and other comorbidities. The Vancouver classification is the most widely used and is helpful for assisting treatment decisions. However, its value for predicting morbidity and mortality has not been assessed. The objective of this retrospective study was to assess post-operative morbidity and mortality according to the fracture type in the Vancouver classification. HYPOTHESIS Post-operative morbidity and mortality vary across fracture types in the Vancouver classification. METHODS A single-centre retrospective study was conducted from 1st January 2010 to 31st December 2015. All patients who had surgery for a PPHF were included. There were 88 patients, including 66 (75%) females, and mean age was 82 years. The patients were re-evaluated at least 3 years after surgery. The distribution of the fracture types was as follows: Vancouver (V) A, n=7; VB, n=63 (VB1, n=30; VB2, n=23; and VB3, n=10); and VC, n=18. Data on the pre-operative status (self-sufficiency, comorbidities, ASA score, etc.) were extracted from the admission files. Morbidity and mortality were evaluated globally and according to the Vancouver type, using the patient files and telephone calls to determine self-sufficiency scores (Parker, Katz, and Lawton) and functional scores (Merle d'Aubigné-Postel [MAP] score and Harris Hip Score [HHS]). RESULTS Post-operative medical complications were very common (33 [37.5%] patients) and correlated with the severity of the fracture. Similarly, the mortality rate at last follow-up varied significantly (p<0.05) with the severity of the fracture, as follows: VA, 28.5%; VB1, 40%; VB2, 47.8%; VC, 55.6%; and VB3, 66.7%). In the overall population, loss of self-sufficiency was 20%, 14%, and 26% according to Parker, Katz, and Lawton, respectively; loss of function was 13.9% and 13.3% according to the MAP score and HHS (p<0.05). All the self-sufficiency scores (Parker, Katz, and Lawton) and functional scores (MAP and HHS) decreased post-operatively in proportion to the severity of the fracture (very small losses for VA and greatest losses for VB3) (p<0.05). CONCLUSION The short- and medium-term mortality rates in our cohort of patients with PPHFs were high and chiefly dependent on the severity of the fractures. The self-sufficiency and functional scores were better in the group with VA fractures than in the groups with VB1, VB2, VB3, and VC fractures. In any case, early weight-bearing is without doubt a key factor in limiting the impact of PPHFs on the functional outcome and on mortality. LEVEL OF EVIDENCE IV, retrospective study.
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Mondanelli N, Troiano E, Facchini A, Cesari M, Colasanti GB, Bottai V, Muratori F, Caffarelli C, Gonnelli S, Giannotti S. Combined Surgical and Medical Treatment for Vancouver B1 and C Periprosthetic Femoral Fractures: A Proposal of a Therapeutic Algorithm While Retaining the Original Stable Stem. Geriatr Orthop Surg Rehabil 2021; 12:21514593211067072. [PMID: 34992896 PMCID: PMC8725223 DOI: 10.1177/21514593211067072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/30/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION There is lack of consensus regarding best operative fixation strategy for periprosthetic femoral fractures (PFFs) around a stable stem. Evidence exists that some patterns of fracture around a stable stem are better treated with revision surgery than with standard fixation. Anyway, a more aggressive surgical procedure together with medical treatment could allow for stem retention, and reduced risk of nonunion/hardware failure, even in these cases. SIGNIFICANCE This paper is placed in a broader context of lack of studies on the matter, and its aim is to shed some light on the management of PFFs around a stable stem, when peculiar mechanical and biological aspects are present. RESULTS Based on our casuistry in the treatment of nonunions after PFF successfully treated with original stem retention, and on review of Literature about risk factors for fixation failure, an algorithm is proposed that can guide in choosing the ideal surgical technique even for first-time PFFs with a stable stem, without resorting to revision. Mechanical (major and minor) and biological (local and systemic) factors that may influence fracture healing, leading to nonunion and hardware failure, and subsequent need for re-operation, are considered. The proposed surgical technique consists of rigid fixation with absolute stability (using a plate and structural allograft) plus local biological support (structural allograft and autologous bone marrow concentrate over a platelet-rich plasma-based scaffold) at fracture site. Systemic anabolic treatment (Teriparatide) is also administered in the post-operative period. CONCLUSION Mechanical factors are not the only issues to be considered when choosing the surgical approach to PFFs over a stable stem. Systemic and local biological conditions should be taken into account, as well. A therapeutic algorithm is proposed, given the prosthetic stem to be stable, considering mechanical and biological criteria.
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Affiliation(s)
- Nicola Mondanelli
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Elisa Troiano
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Andrea Facchini
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Martina Cesari
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | | | - Vanna Bottai
- Second Clinic of Orthopedic and
Traumatology, University of Pisa, Pisa, Italy
| | - Francesco Muratori
- Section of Orthopedic Oncology and
Reconstructive Surgery, Azienda Ospedaliero-Universitaria
Careggi, Firenze, Italy
| | - Carla Caffarelli
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Internal Medicine, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Stefano Gonnelli
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Internal Medicine, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Stefano Giannotti
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
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Caruso G, Corradi N, Amoroso T, Martini I, Lorusso V, Massari L. Atypical periprosthetic femur fracture on an underestimated atypical femoral pattern. A case report. Trauma Case Rep 2021; 32:100407. [PMID: 33665304 PMCID: PMC7900765 DOI: 10.1016/j.tcr.2021.100407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 12/12/2022] Open
Abstract
Case Atypical fracture patterns, especially to the femur midshaft, have begun emerging since long-term bisphosphonate use was introduced. The same fracture pattern could arise around prosthetic hip implant, but the literature reports few cases regarding atypical periprosthetic femur fracture on previous total hip arthroplasty implant in patients on long-term bisphosphonate therapy. To our knowledge we report here the first case of atypical periprosthetic femur fracture arising after total hip arthroplasty implant on a previously identified but underestimated atypical femur pattern. Conclusion Surgeons should never underestimate an atypical femur pattern on x-rays and always relate groin and thigh pain to hip pathology before performing total hip arthroplasty.
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Affiliation(s)
- Gaetano Caruso
- Orthopedic and Traumatology Unit, Sant'Anna University Hospital of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy.,Department of Neurosciences and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Nicola Corradi
- Orthopedic and Traumatology Unit, Sant'Anna University Hospital of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
| | - Tommaso Amoroso
- Orthopedic and Traumatology Unit, Sant'Anna University Hospital of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
| | - Ilaria Martini
- Orthopedic and Traumatology Unit, Sant'Anna University Hospital of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
| | - Vincenzo Lorusso
- Orthopedic and Traumatology Unit, Sant'Anna University Hospital of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
| | - Leo Massari
- Orthopedic and Traumatology Unit, Sant'Anna University Hospital of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy.,Department of Neurosciences and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
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Patsiogiannis N, Kanakaris NK, Giannoudis PV. Periprosthetic hip fractures: an update into their management and clinical outcomes. EFORT Open Rev 2021; 6:75-92. [PMID: 33532088 PMCID: PMC7845569 DOI: 10.1302/2058-5241.6.200050] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The Vancouver classification is still a useful tool of communication and stratification of periprosthetic fractures, but besides the three parameters it considers, clinicians should also assess additional factors. Combined advanced trauma and arthroplasty skills must be available in departments managing these complex injuries. Preoperative confirmation of the THA (total hip arthroplasty) stability is sometimes challenging. The most reliable method remains intraoperative assessment during surgical exploration of the hip joint. Certain B1 fractures will benefit from revision surgery, whilst some B2 fractures can be effectively managed with osteosynthesis, especially in frail patients. Less invasive osteosynthesis, balanced plate–bone constructs, composite implant solutions, together with an appropriate reduction of the limb axis, rotation and length are critical for a successful fixation and uneventful fracture healing.
Cite this article: EFORT Open Rev 2021;6:75-92. DOI: 10.1302/2058-5241.6.200050
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Affiliation(s)
| | - Nikolaos K Kanakaris
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds, UK.,NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
| | - Peter V Giannoudis
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds, UK.,NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
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Omari A, Nielsen CS, Husted H, Otte KS, Troelsen A, Gromov K. Introduction of a New Treatment Algorithm Reduces the Number of Periprosthetic Femoral Fractures After Primary Total Hip Arthroplasty in Elderly Females. J Arthroplasty 2020; 35:3613-3620. [PMID: 32768258 DOI: 10.1016/j.arth.2020.06.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/10/2020] [Accepted: 06/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Increasing global usage of cementless prostheses in total hip arthroplasty (THA) presents a challenge, especially for elderly patients. To reduce the risk of early periprosthetic femoral fractures (PFFs), a new treatment algorithm for females older than 60 years undergoing primary THA was introduced. The aim of this study was to determine the impact of the new treatment algorithm on the early risk of perioperative and postoperative PFFs and guideline compliance. METHODS A total of 2405 consecutive THAs that underwent primary unilateral THA at our institution were retrospectively identified in the period January 1, 2013-December 31, 2018. A new treatment algorithm was introduced on April 1, 2017 with female patients aged older than 60 years intended to receive cemented femoral components. Before this, all patients were scheduled to receive cementless femoral components. Demographic data, number of perioperative and postoperative PFFs, and surgical compliance were recorded, analyzed, and intergroup differences compared. RESULTS The utilization of cemented components in female patients older than 60 years increased from 12.3% (n = 102) to 82.5% (n = 264). In females older than 60 years, a significant reduction in the risk in early postoperative and intraoperative PFF after introduction of the new treatment algorithm was seen (4.57% vs 1.25%; P = .007 and 2.29% vs 0.31%; P = .02, respectively). Overall risk for postoperative and intraoperative fractures combined was also reduced in the entire cohort (4.1% vs 2.0%; P = .01). CONCLUSION Use of cemented fixation of the femoral component in female patients older than 60 years significantly reduces the number of PFFs. Our findings support use of cemented femoral fixation in elderly female patients.
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Affiliation(s)
- Adam Omari
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Copenhagen, Denmark
| | - Christian S Nielsen
- Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Copenhagen, Denmark
| | - Henrik Husted
- Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Copenhagen, Denmark
| | - Kristian S Otte
- Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Copenhagen, Denmark
| | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Copenhagen, Denmark
| | - Kirill Gromov
- Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Copenhagen, Denmark
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Wang Q, Li D, Kang P. Uncemented extensive porous titanium-coated long femoral stem prostheses are effective in treatment of Vancouver type B2 periprosthetic femoral fractures: A retrospective mid- to long-term follow-up study. J Orthop Surg (Hong Kong) 2020; 27:2309499019857653. [PMID: 31232172 DOI: 10.1177/2309499019857653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the mid- to long-term outcomes of revision surgery for Vancouver type B2 periprosthetic femoral fractures (PFFs) after total hip arthroplasty using an uncemented extensive porous titanium-coated long femoral stem prosthesis (solution prosthesis) with or without cortical strut allograft. METHODS A total of 34 patients with Vancouver type B2 PFFs who underwent revision hip arthroplasty using a posterolateral approach and received a solution prosthesis at our institution from December 2006 to January 2014 were retrospectively recruited. Patients were asked to assess their walking ability and pain status using a questionnaire. Limb function, pain, and physical and mental health were assessed using the Harris Hip score, University of California-Los Angeles score, Western Ontario and McMaster Universities osteoarthritis index, and Short Form-12 Health Survey score. Patients were also asked to rate their satisfaction with the surgery. Fracture union and stress shielding were assessed by radiography, and computed tomography was used to assess stem fixation. Single-photon emission computed tomography performed to assess radionuclide distribution in patients given cortical strut allografts. Patients were asked about their condition before PFF and evaluated at 6 weeks, 3 months, 6 months, 1 year, and annually after surgery. Any complications during follow-up were recorded. RESULTS Of the 34 patients, 29 completed follow-up. There was no significant difference in patient's health before PFF or at the last follow-up. Fracture union was achieved in all patients. Mild-to-moderate stress shielding occurred in three patients, and no patients exhibited femoral stem loosening or obvious subsidence. Radionuclides were concentrated in the cortical strut transplantation area, and the cortical strut was integrated with the host femur. The incidence of postoperative complications was low. CONCLUSIONS Revision surgery using the solution prosthesis with or without cortical strut allograft is effective in treating Vancouver type B2 PFFs, with satisfactory mid- and long-term clinical and radiological outcomes.
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Affiliation(s)
- Qiuru Wang
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Donghai Li
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Pengde Kang
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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