Perioperative periprosthetic femur fracture associated with direct anterior total hip arthroplasty using metaphyseal fit and fill stem

Prophylactic Cabling of the Femur in Revision Total Hip Arthroplasty Lowers the Risk of Vancouver B2 and B3 Acute Periprosthetic Fractures and Reoperations

INTRODUCTION

Periprosthetic femoral fractures (PPFx) represent a common cause of revision total hip arthroplasty (THA). Among PPFx, Vancouver B2 and B3 are more challenging, often requiring reoperation and femoral stem revision. Cables have been shown to reduce stem subsidence, fracture propagation, and stress during axial loading. However, there is a paucity of literature on the role of prophylactic cabling during revision THA. Therefore, this study aimed to determine the acute PPFx rate and types of PPFx in revision THA for patients who had prophylactic cables compared to those who did not have cables.

METHODS

This retrospective study identified patients who underwent revision THA at our institution. Current procedural terminology codes and radiographic images were reviewed to group patients into the cables or no cables cohorts. The primary outcome was the rate of acute PPFx (< 30 days postoperatively). Secondary outcomes were the Vancouver classification of PPFx, reoperations for PPFx, and all-cause re-revisions.

RESULTS

There were 2,977 patients identified: 192 who had and 2,785 who did not have cables. There was no difference in acute PPFx rates between the prophylactic cables and no cables (1.56 versus 2.08%, P = 0.80). However, cabling substantially lessened the more complex B2 and B3 fractures and reoperation rates. In the prophylactic cable group, 100% of the fractures were B1 compared to 30 B1 (51.7%), 16 B2 (27.5%), nine B3 (15.5%), and three C (5.2%) fractures in the no cables cohort. Reoperation rates for acute PPFx were significantly lower in the cables cohort (33.3%) than in the no cables cohort (50.0%), P = 0.022. All-cause re-revisions were also significantly lower in those who had cables (7.3 versus 12.8%, P = 0.038).

CONCLUSION

Prophylactic cabling for taper fluted, diaphyseal fitting stems protects against more complex Vancouver B2 and B3 fractures while reducing reoperations. In revision THA, surgeons should consider prophylactically cabling the femur to lessen the risk of reoperation and complex fracture.

A Retrospective Study on the Incidence of Periprosthetic Fractures Related to Total Hip Arthroplasty and Postoperative Complications During Hospitalization

Background/Objectives: Periprosthetic fractures (PFs) are serious complications that can occur after total hip arthroplasty (THA), particularly in elderly patients who often have multiple comorbidities and low bone density. The surgical treatment of PFs typically involves internal fixation or revision arthroplasty, depending on the fracture type categorized by the Vancouver classification. This study examines the annual incidence of PFs and the complications that arise during hospitalization, as well as the predictive role of age in the occurrence of these fractures and their associated complications. Methods: Based on a retrospective observational study conducted over three years (2021-2023) at the Bihor County Emergency Hospital in Oradea, we analyzed 783 patients who underwent various hip surgeries. Results: The retrospective analysis identified 38 cases of PF out of 768 hip surgeries, resulting in an incidence of PF of 4.5%. Most PFs were classified as Vancouver B, with surgeries mainly involving internal fixation. Complications occurred in 23.68% of cases, including a mortality rate of 7.90%. A correlation analysis examining the relationship between age and post-surgical complications demonstrates a weak and statistically insignificant association (r = 0.120, p = 0.478). To highlight whether age is a predictive factor for PFs, we used the linear regression model; this suggests that older age explains 2.7% of the total variability in the incidence of PFs, being statistically significant ([F(1, 766) = 20.923], p < 0.001). Conclusions: The rising incidence of periprosthetic fractures is closely linked to the increasing number of total hip arthroplasties and the aging population. Fractures of this type are more common in elderly women, with no statistically significant differences have been found between the sexes.

What's New in Periprosthetic Femur Fractures?

BACKGROUND

Periprosthetic femur fracture (PFF) is one of the most common indications for reoperation following total hip arthroplasty.

METHODS/RESULTS

This article provides a review of a symposium on PFF that was presented at the American Association of Hip and Knee Surgeons 2023 annual meeting, including an overview of the Vancouver classification and its implications on treatment and subsequent complications, an updated approach to the management of intraoperative fractures, and finally, contemporary strategies for both osteosynthesis as well as revision arthroplasty for PFFs.

CONCLUSION

As the incidence of PPF continues to increase, arthroplasty and trauma surgeons must be prepared to address this challenging complication with a contemporary understanding of the treatment options and their outcomes.