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Ko YS, Lee HJ, Kim HS, Yoo JJ. Ipsilateral pubic ramus fracture during total hip arthroplasty is not rare: does it matter? Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05368-5. [PMID: 38743113 DOI: 10.1007/s00402-024-05368-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/05/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Periprosthetic fractures in total hip arthroplasty (THA) have been well described and studied. However, there is a lack of reports on ipsilateral pubic ramus fractures during THA due to the rare occurrence of such fractures and ambiguity of symptoms. With the use of postoperative computed tomography (CT) examinations, we have identified that asymptomatic ipsilateral pubic ramus fractures occur frequently during THA. This study aims to evaluate the incidence, location, clinical outcomes, and risk factors of ipsilateral pubic ramus fractures during THA. METHODS From May 2022 to March 2023, a single surgeon performed 203 THAs in 183 patients at a single institution. All patients underwent postoperative CT scans three days after THA. The patients with ipsilateral pubic ramus fractures were followed up for a minimum of six months. Basic demographics, osteoporosis, general conditions of the operations, and outcomes of THA were investigated in all patients. RESULTS Twenty-two cases (10.8%) of ipsilateral pubic ramus fractures were identified on postoperative CT scans. All fractures were located near the origin of the superior or inferior pubic ramus. Five fractures were detected on simple postoperative radiographs. The fractures did not cause any further complications at a minimum of six-month postoperative follow-up. Univariate and multivariate analyses did not identify any risk factors associated with these fractures. CONCLUSIONS Although the incidence of ipsilateral pubic ramus fractures during THA is high, treatment is not required as they do not cause any significant clinical symptoms or affect the prognosis of THA. However, the possibility of occurrence of these fractures must be explained to the patients before surgery.
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Affiliation(s)
- Young-Seung Ko
- Department of Orthopaedic Surgery, Hallym university Dong-Tan Sacred Heart Hospital, Hwaseong, South Korea
| | - Han Jin Lee
- Department of Orthopaedic Surgery, Hanil Hospital, Seoul, South Korea
| | - Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Jeong Joon Yoo
- Department of Orthopaedic Surgery, Hallym university Dong-Tan Sacred Heart Hospital, Hwaseong, South Korea.
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.
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Yagura T, Oe K, Kobayasi F, Sogawa S, Nakamura T, Iida H, Saito T. Experimental periprosthetic fractures with collarless polished tapered cemented stems. INTERNATIONAL ORTHOPAEDICS 2024; 48:1171-1178. [PMID: 38443715 DOI: 10.1007/s00264-024-06136-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE After cemented total hip arthroplasty, the risk of periprosthetic fracture (PPF) of taper-slip stems is higher than that of composite-beam stems. We aimed to assess the conditions resulting in PPFs of taper-slip stems using a falling weight. METHODS Taper-slip stems were fixed to five types of simulated bone models using bone cement, and the fractures were evaluated by dropping stainless-steel weights from a predetermined height onto the heads. The periprosthetic fracture height in 50% of the bone models (PPFH50) was calculated using the staircase method. RESULTS For the fixation with 0° of flexion, the values for PPFH50 were 61 ± 11, 60 ± 13, above 110, 108 ± 49, and 78 ± 12 cm for the cobalt-chromium-molybdenum alloy, stainless steel alloy (SUS), titanium alloy (Ti), smooth surface, and thick cement mantle models, respectively; for the fixation with 10° of flexion (considering flexure), the PPFH50 values were 77 ± 5, 85 ± 9, 90 ± 2, 89 ± 5, and 81 ± 11 cm, respectively. The fracture rates of the polished-surface stems were 78.6 and 35.7% at the proximal and distal sites, respectively (p < 0.05); the fracture rates of the smooth-surface stems were 14.2 and 100%, respectively (p < 0.05). CONCLUSION The impact tests demonstrated that the conditions that were less likely to cause PPFs were use of Ti, a smooth surface, a thick cement mantle, and probably, use of SUS.
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Affiliation(s)
- Takuma Yagura
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Kenichi Oe
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
| | - Fumito Kobayasi
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Shohei Sogawa
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Tomohisa Nakamura
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Hirokazu Iida
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Takanori Saito
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
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Chen B, Clement ND, Scott CEH. Risk factors influencing periprosthetic fracture and mortality in elderly patients following hemiarthroplasty with a cemented collarless polished taper stem for an intracapsular hip fracture. Bone Jt Open 2024; 5:269-276. [PMID: 38572531 PMCID: PMC10993022 DOI: 10.1302/2633-1462.54.bjo-2023-0140.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Aims The aims of this study were to evaluate the incidence of reoperation (all cause and specifically for periprosthetic femoral fracture (PFF)) and mortality, and associated risk factors, following a hemiarthroplasty incorporating a cemented collarless polished taper slip stem (PTS) for management of an intracapsular hip fracture. Methods This retrospective study included hip fracture patients aged 50 years and older treated with Exeter (PTS) bipolar hemiarthroplasty between 2019 and 2022. Patient demographics, place of domicile, fracture type, delirium status, American Society of Anesthesiologists (ASA) grade, length of stay, and mortality were collected. Reoperation and mortality were recorded up to a median follow-up of 29.5 months (interquartile range 12 to 51.4). Cox regression was performed to evaluate independent risk factors associated with reoperation and mortality. Results The cohort consisted of 1,619 patients with a mean age of 82.2 years (50 to 104), of whom 1,100 (67.9%) were female. In total, 29 patients (1.8%) underwent a reoperation; 12 patients (0.7%) sustained a PFF during the observation period (United Classification System (UCS)-A n = 2; UCS-B n = 5; UCS-C n = 5), of whom ten underwent surgical management. Perioperative delirium was independently associated with the occurrence of PFF (hazard ratio (HR) 5.92; p = 0.013) and surgery for UCS-B PFF (HR 21.7; p = 0.022). Neither all-cause reoperation nor PFF-related surgery was independently associated with mortality (HR 0.66; p = 0.217 and HR 0.38; p = 0.170, respectively). Perioperative delirium, male sex, older age, higher ASA grade, and pre-fracture residential status were independently associated with increased mortality risk following hemiarthroplasty (p < 0.001). Conclusion The cumulative incidence of PFF at four years was 1.1% in elderly patients following cemented PTS hemiarthroplasty for a hip fracture. Perioperative delirium was independently associated with a PFF. However, reoperation for PPF was not independently associated with patient mortality after adjusting for patient-specific factors.
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Affiliation(s)
- Bin Chen
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, China
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick D. Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - Chloe E. H. Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
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Fraval A, Hegeman EM, Krueger CA. Management of Isolated Greater Trochanter Fractures Associated With Total Hip Arthroplasty. J Am Acad Orthop Surg 2024; 32:196-204. [PMID: 38147680 DOI: 10.5435/jaaos-d-23-00560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/08/2023] [Indexed: 12/28/2023] Open
Abstract
Periprosthetic hip fractures are recognized complications associated with total hip arthroplasty. Over the past decade, there has been a 2.5-fold increase in the incidence of periprosthetic fractures which is expected to grow exponentially in the future. Most of these fractures require surgical fixation or revision arthroplasty. Fractures of the greater trochanter represent a subset of periprosthetic fractures for which there is currently no consensus in the literature regarding the optimal management. The purpose of this review was to outline the management strategies available to address these fractures, with formulation of recommendations for fractures sustained intraoperatively, postoperatively, and in the setting of primary and revision total hip arthroplasty.
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Affiliation(s)
- Andrew Fraval
- From the Rothman Orthopedic Institute at Thomas Jefferson University (Fraval, and Krueger), and Department of Orthopaedic Surgery, San Antonio Military Medical Center (Hegeman)
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Lucena T, Cavaignac E, Courtot L, Marot V, Chiron P, Reina N. Implant breakage and revision factors for modular fluted tapered stems in revision total hip arthroplasty. Hip Int 2024; 34:207-214. [PMID: 37306180 DOI: 10.1177/11207000231180065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Modular stems in revision total hip arthroplasties allow diaphyseal fixation and optimal restoration of the architecture of the proximal femur. Several studies report metaphyseal implant breakage having a negative impact on survivorship. The aim of the study was to evaluate the outcome of an uncemented modular fluted tapered stem (MFT) in revision surgery. METHODS In a retrospective study, 316 patients who had revision surgery using the same design of MFT implant (Modular Revision Stem [MRS], Lima Corporate, Italy) between 2012 and 2017 were identified. Patients were male in 51% of cases and mean age was 74 years. Indications were 110 periprosthetic fractures, 98 periprosthetic joint infection, 97 aseptic loosening, 10 instability and 1 other cause. Survivorship, complications, clinical and radiographic outcomes, were assessed. Mean follow-up was 5 years. RESULTS There was no implant breakage. At 5-year follow-up, the survivorship, free from revision for aseptic loosening and free of revision for any reason were 96% and 87%, respectively. At last follow-up (8 years), these figures were 92% and 71%, respectively. 31 implants were revised. The risk of revision for any cause was higher for extreme length metaphyseal implants, hazard ratio was 3.7 (95% CI, 1.82-7.52). A mean stem subsidence of 9 mm was noted in 37 cases; 4 were revised for aseptic loosening. The Harris Hip Score at final follow-up was 82. CONCLUSIONS At 5-year follow-up, the MFT implant showed a good survivorship and outcomes with no specific complications. Unlike literature reports, no specific complications occurred with this design. Stem junction positioning and therefore metaphyseal length may be key to optimise long-term survivorship. However, a longer follow-up is needed as implant breakage is more often seen after long implantation times.
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Affiliation(s)
- Thibaut Lucena
- Department of Orthopaedic Surgery and Trauma, Pierre Paul Riquet University Hospital, Toulouse, France
| | - Etienne Cavaignac
- Department of Orthopaedic Surgery and Trauma, Pierre Paul Riquet University Hospital, Toulouse, France
- I2R - Institut de Recherche Riquet, Toulouse, France
| | - Louis Courtot
- Department of Orthopaedic Surgery and Trauma, Pierre Paul Riquet University Hospital, Toulouse, France
| | - Vincent Marot
- Orthopaedics Unit, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | - Philippe Chiron
- Department of Orthopaedic Surgery and Trauma, Pierre Paul Riquet University Hospital, Toulouse, France
| | - Nicolas Reina
- Department of Orthopaedic Surgery and Trauma, Pierre Paul Riquet University Hospital, Toulouse, France
- I2R - Institut de Recherche Riquet, Toulouse, France
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Sahemey R, Ridha A, Stephens A, Farhan-Alanie MM, Kozdryk J, Riemer B, Foguet P. Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis. ARTHROPLASTY 2024; 6:4. [PMID: 38191524 PMCID: PMC10775576 DOI: 10.1186/s42836-023-00228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Femoral reconstruction with long stems is widely accepted as the standard in revision total hip arthroplasty (rTHA). However, long stems can be technically challenging to insert and can compromise bone stock for future revision. This study aimed to identify whether there was a difference in outcomes with using a long versus primary or short femoral stem in revision. METHODS We performed a systematic review and meta-analysis of all articles comparing long and primary stem length in rTHA for Paprosky 1-3B femoral defects. The primary outcome measure was the reoperation rate after rTHA. Secondary outcomes included infection and dislocation rates, periprosthetic fracture, loosening, mortality, and patient-reported outcome measures (PROMs). RESULTS The results of 3,102 rTHAs performed in 2,982 patients were reported from 9 eligible studies in the systematic review, of which 6 were included in the meta-analysis. The mean patient age was 67.4 and the mean follow-up lasted 5 years (range, 1-15 years). There was no significant difference in the reoperation rate (odds ratio 0.78; 95% confidence interval, 0.28-2.17, P = 0.63). Similarly, there was no significant difference in dislocation or periprosthetic fracture risk. Harris Hip Score was better with primary stems by a mean difference of 14.4 points (P < 0.05). Pooled 5-year stem-related survival was 91.3% ± 3.5% (SD) for primary stems and 89.9% ± 6.7% (SD) for long stems. CONCLUSIONS A primary stem provided non-inferior outcomes compared with long stems in rTHA with Paprosky type 1-3B femoral defects. Primary stems may yield a more straightforward technique and preserve distal bone stock for future revision particularly in younger patients. In older patients with lower functional demands and who would benefit from a decreased risk of complications, a long cemented stem is recommended.
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Affiliation(s)
- Rajpreet Sahemey
- Department of Trauma & Orthopaedics, University Hospitals Coventry & Warwickshire, Coventry, CV2 2DX, UK.
| | - Ali Ridha
- Department of Trauma & Orthopaedics, University Hospitals Coventry & Warwickshire, Coventry, CV2 2DX, UK
| | - Alastair Stephens
- Department of Trauma & Orthopaedics, University Hospitals Coventry & Warwickshire, Coventry, CV2 2DX, UK
| | - Muhamed M Farhan-Alanie
- Department of Trauma & Orthopaedics, University Hospitals Coventry & Warwickshire, Coventry, CV2 2DX, UK
| | - Jakub Kozdryk
- Department of Trauma & Orthopaedics, University Hospitals Coventry & Warwickshire, Coventry, CV2 2DX, UK
| | - Bryan Riemer
- Department of Trauma & Orthopaedics, University Hospitals Coventry & Warwickshire, Coventry, CV2 2DX, UK
| | - Pedro Foguet
- Department of Trauma & Orthopaedics, University Hospitals Coventry & Warwickshire, Coventry, CV2 2DX, UK
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Messner M, Jacob R, Hagewood J, Broadfoot J, Chandler K, Medawar N, Prahad S, Naranje S. Bone remodeling and cortical thinning distal to the femoral stem: a retrospective review. Arch Orthop Trauma Surg 2023; 143:6461-6467. [PMID: 37055631 DOI: 10.1007/s00402-023-04860-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/25/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION There is a paucity of information on the bone remodeling that occurs distal to the femoral stem following total hip arthroplasty as most previous studies have focused on proximal changes. In this study, we report the cortical thinning that occur distal to the femoral stem after primary total hip arthroplasty. METHODS A retrospective review was performed at one institution over a 5-year period. 156 primary total hip arthroplasty procedures were included. The Cortical Thickness Index (CTI) was measured on both operative and non-operative hips at 1 cm, 3 cm and 5 cm below the prosthetic stem tip on anteroposterior radiographic images pre-operatively as well as at 6 months, 12 months and 24 months post-operatively. The difference in average CTI was measured using paired t-tests. RESULTS There were statistically significant decreases in CTI distal to the femoral stem at 12 months and 24 months (-1.3% and -2.8%, respectively). Greater losses were seen in female patients, patients older than 75, and patients with BMI less than 35 at 6 months postoperative. There were no differences in CTI at any time point on the non-operative side. CONCLUSION The current study demonstrates that patients undergo bone loss as measured by CTI distal to the stem in the first 2 years following total hip arthroplasty. Comparison to the contralateral non-operative side confirms that this change is greater than expected for the natural aging process. A greater understanding of these changes will help optimize post-operative management and direct future innovations in implant design.
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Affiliation(s)
- Mitchell Messner
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roshan Jacob
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jacob Hagewood
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jackson Broadfoot
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly Chandler
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nick Medawar
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sri Prahad
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sameer Naranje
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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DeFrancesco CJ. CORR Insights®: How Often Do Complications and Mortality Occur After Operatively Treated Periprosthetic Proximal and Distal Femoral Fractures? A Register-based Study. Clin Orthop Relat Res 2023; 481:1950-1953. [PMID: 37133402 PMCID: PMC10499091 DOI: 10.1097/corr.0000000000002686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/07/2023] [Indexed: 05/04/2023]
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Zhao WQ, Li XS, Fan MQ, Yao ZY, Song ZF, Tong PJ, Huang JF. Surgical treatment of specific Unified Classification System B fractures: potentially destabilising lesser trochanter periprosthetic fractures. Sci Rep 2023; 13:14330. [PMID: 37653006 PMCID: PMC10471595 DOI: 10.1038/s41598-023-41698-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/30/2023] [Indexed: 09/01/2023] Open
Abstract
To investigate the clinical effects of specific Unified Classification System B (UCS B)-lesser trochanter periprosthetic fractures and determine whether they occur only with non-cemented stems. A retrospective analysis of 28 patients with specific UCS B2 fractures who underwent two surgical treatments, longer stem revision and internal fixation (LSRIF) and open reduction and internal fixation (ORIF), was performed. The patients were assessed at 1, 3, 6, 12, and 24 months and annually thereafter. Fracture healing, complications, Harris Hip Score (HHS), and the Short Form Health Survey questionnaire (SF-36) quality of life score were assessed at each follow-up. At the time of the last follow-up, seven patients had been lost: three were lost to contact, two died, and two were hospitalised elsewhere and unavailable for follow-up. The remaining 21 patients were followed for an average of 49.3 ± 15.4 (range: 24-74.4) months. Their average fracture healing time was 13.5 ± 1.1 (12-15.4) weeks. Complications included three cases (10.71%) of thrombus, one (3.57%) of heart failure, and one (3.57%) of pulmonary infection. There were no revisions due to prosthesis loosening, subsidence, or infection. At the last follow-up, the HHS, SF-36 mental score, and SF-36 physical score were recorded, LSRIF vs. ORIF (82.9 ± 6.6 vs. 74.7 ± 3.9, p = 0.059; 50.9 ± 7.6 vs. 38 ± 1.4, p = 0.012, and 51.7 ± 8.4 vs. 39.7 ± 3.4, p = 0.032, respectively). Specific UCS B2 fractures mostly occur with non-cemented stems. LSRIF with cables is the main treatment, while ORIF is an option for those elderly in poor condition.
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Affiliation(s)
- Wei-Qiang Zhao
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China
| | - Xu-Song Li
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, 528401, Guangdong, China
| | - Meng-Qiang Fan
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China
| | - Zhi-Yuan Yao
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China
| | - Zhou-Feng Song
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China
| | - Pei-Jian Tong
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, China.
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China.
| | - Jie-Feng Huang
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, China.
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China.
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Madanipour S, Singh P, Patel A, Beg R, Sha M, Grewal IS, Iranpour F, Subramanian P. Subsidence in Centraliser Sign: A Novel Tool to Help Predict Early Subsidence in Periprosthetic Femoral Fractures Around Polished Tapered Stems Treated With Internal Fixation. Cureus 2023; 15:e42742. [PMID: 37654957 PMCID: PMC10467608 DOI: 10.7759/cureus.42742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
Background When treating periprosthetic femoral fractures (PPF) around polished taper slip stems (PTS), determining which patients can be successfully treated with internal fixation can be challenging. We have described the subsidence-in-centraliser (SINC) sign as a radiographic feature of PPF around PTS stems. We hypothesise that a positive SINC sign can help predict a poorer outcome for the fixation of these fractures. Patients and methods Retrospective identification of PPFs around cemented PTS with an appreciable centraliser on radiographs was conducted at a single centre. A positive SINC sign was defined as a post-injury radiograph demonstrating >50% reduction in the radiographic lucency representing the stem centraliser when compared to pre-injury films or complete obliteration of distal lucency when no pre-injury film was available. The primary outcome was the rate of subsequent stem subsidence on follow-up radiographs comparing SINC-positive and SINC-negative fractures, which were managed with open reduction and internal fixation (ORIF). Results Fifty-four patients were included in the analysis. The mean age was 76.8 years, and the mean follow-up for all patients was 12.7 months. Thirty-five fractures were deemed SINC-positive, and 19 were SINC-negative. 17/17 (100%) SINC-positive fractures managed with fixation underwent further subsidence (mean 5.4 mm, SD 2.8). A positive SINC sign demonstrated a sensitivity of 90.5% and specificity of 100% for subsequent stem subsidence in fractures treated without revision. SINC positive fractures underwent significantly more subsidence compared with SINC negative fractures when fixed (5.4 mm vs. 0.28 mm, U = 6.50, p<0.001) at a mean follow-up of 12.7 months. The SINC sign demonstrated strong inter- (k=0.96) and intra-rater (k=0.86) reliability. Conclusion The SINC sign can serve as a useful adjunct in the decision to fix or revise PPF around PTS. A positive SINC sign may represent a cement mantle that cannot be reconstituted anatomically, leading to subsidence after treatment with ORIF.
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Affiliation(s)
| | - Prashant Singh
- Trauma and Orthopaedics, Royal Free London NHS Trust, London, GBR
| | - Arpit Patel
- Trauma and Orthopaedics, Royal Free London NHS Trust, London, GBR
| | - Ruqqayyah Beg
- Trauma and Orthopaedics, University College London Medical School, London, GBR
| | - Menazir Sha
- Trauma and Orthopaedics, University College London Medical School, London, GBR
| | - Ishvinder S Grewal
- Orthopaedic Surgery, University of Texas (UT) Southwestern Medical Center, Dallas, USA
| | - Farhad Iranpour
- Trauma and Orthopaedics, Royal Free London NHS Trust, London, GBR
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11
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Scott CEH, Jain S, Moran M, Haddad FS. Which Unified Classification System type B periprosthetic fractures around cemented polished tapered stems should not be fixed? Bone Joint J 2023; 105-B:481-486. [PMID: 37121589 DOI: 10.1302/0301-620x.105b5.bjj-2022-1395.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The Unified Classification System (UCS), or Vancouver system, is a validated and widely used classification system to guide the management of periprosthetic femoral fractures. It suggests that well-fixed stems (type B1) can be treated with fixation but that loose stems (types B2 and B3) should be revised. Determining whether a stem is loose can be difficult and some authors have questioned how to apply this classification system to polished taper slip stems which are, by definition, loose within their cement mantle. Recent evidence has challenged the common perception that revision surgery is preferable to fixation surgery for UCS-B periprosthetic fractures around cemented polished taper slip stems. Indications for fixation include an anatomically reducible fracture and cement mantle, a well-fixed femoral bone-cement interface, and a well-functioning acetabular component. However, not all type B fractures can or should be managed with fixation due to the risk of early failure. This annotation details specific fracture patterns that should not be managed with fixation alone.
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Affiliation(s)
- Chloe E H Scott
- Department of Orthopaedics, The University of Edinburgh, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Matt Moran
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK
- The Princess Grace Hospital, London, UK
- The Bone & Joint Journal , London, UK
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12
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Binkley N, Nickel B, Anderson PA. Periprosthetic fractures: an unrecognized osteoporosis crisis. Osteoporos Int 2023; 34:1055-1064. [PMID: 36939852 DOI: 10.1007/s00198-023-06695-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/02/2023] [Indexed: 03/21/2023]
Abstract
Total joint replacement is common and increasing. Many of these patients have low bone mineral density preoperatively, and arthroplasty leads to bone loss. As falls are common before and after arthroplasty, it is unsurprising that periprosthetic fractures, defined as those associated with an orthopedic device, whether a joint replacement or other internal fixation devices, are not rare. These fractures engender morbidity and mortality comparable to osteoporosis-related hip fractures but remain largely unrecognized and untreated by osteoporosis/metabolic bone disease clinicians. Indeed, recent osteoporosis guidelines are silent regarding periprosthetic fractures. The purposes of this clinical review are to briefly describe the epidemiology of arthroplasty procedures and periprosthetic fractures, raise awareness that these fractures are osteoporosis-related, and suggest approaches likely to reduce their occurrence. Notably, bone health evaluation is essential following the occurrence of a periprosthetic fracture to reduce subsequent fracture risk. Importantly, in addition to such secondary fracture prevention, primary prevention, i.e., bone health assessment and optimization prior to elective orthopedic procedures, is appropriate.
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Affiliation(s)
- Neil Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA.
| | - Brian Nickel
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, USA
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, USA
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13
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Fink B, Ahmadian A. Outcomes of osteosynthesis of periprosthetic fractures of the greater trochanter with an anatomic claw plate. J Clin Orthop Trauma 2023; 38:102123. [PMID: 36846072 PMCID: PMC9945795 DOI: 10.1016/j.jcot.2023.102123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/12/2023] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Abstract
Background The treatment of periprosthetic trochanteric fractures, especially older fractures, is often a challenge. The aim of this study was to investigate the clinical and radiological outcomes of periprosthetic fracture treatment with the anatomic Peri-Plate claw plate. Material and methods Thirteen new fractures (≤6 weeks after occurrence) and 8 older Vancouver AG fractures (35.4 ± 26.1 weeks after occurrence) were followed radiologically and clinically with a follow-up of 44.6 ± 18.8 (24-81) months. Results At 6 months, osseous consolidation had occurred in 12 cases and fibrous union in 9 cases. At 12 months one additional osseous consolidation was shown. The Harris hip score (HHS) increased from 37.2 ± 10.3 preoperatively to 87.6 ± 10.3 12 months after surgery. Thirteen patients reported no, 7 mild and one patient significant local trochanteric pain. Conclusions The Peri-Plate claw plate can achieve reproducibly good outcomes in terms of fracture stabilization and bony consolidation, as well as with regard to clinical outcomes in the treatment of new and older periprosthetic trochanteric fractures.
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Affiliation(s)
- Bernd Fink
- Department for Joint Replacement, Rheumatoid and General Orthopaedics, Orthopaedic Clinic Markgröningen, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Germany
- Orthopaedic Department, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Arman Ahmadian
- Department for Joint Replacement, Rheumatoid and General Orthopaedics, Orthopaedic Clinic Markgröningen, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Germany
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14
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Padilla-Rojas LG, Garín-Zertuche DE, López-Almejo L, Garabano G, Pesciallo CÁ, Leal JA, Pinzón A, Giordano V, Esteves-Pires R. Periprosthetic fracture management of the proximal femur. OTA Int 2023; 6:e246. [PMID: 37006453 PMCID: PMC10064640 DOI: 10.1097/oi9.0000000000000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/22/2022] [Indexed: 03/30/2023]
Abstract
The most common periprosthetic fractures occur around the hip. The most widely used classification is the Vancouver classification, and management requires careful planning and skill in both arthroplasty and fracture surgery. This article presents an overview of the diagnosis, classification, and management of periprosthetic fractures of the proximal femur. This work represents a summary review from Latin American Society Members of the International Orthopaedic Trauma Association.
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15
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[Strategies for stem revision : Surgery planning, implant removal and reimplantation]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:21-34. [PMID: 35802156 PMCID: PMC9842594 DOI: 10.1007/s00132-022-04277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PLANNING Femoral revision represents a challenging procedure in its surgical planning and technical execution. The results are mainly dependent on the bone loss present, the quality of the implant removal and the choice of revision system. Patient-specific factors such as age, comorbidities, bone quality or even the localization of the cement have a decisive influence on the surgical strategy. Appropriate preoperative preparation, including the presence of the necessary special instruments, which are essential for gentle implant removal, is indispensable to achieve the best possible result. THERAPY A bone-sparing implant removal can be particularly challenging, especially in the case of well-fixed stems and cement residues, which may extend far beyond the isthmus. In such situations, a transfemoral approach should be considered. Cementless reimplantation using modular or non-modular titanium stems is currently the preferred treatment of choice for most revisions. In elderly, low-demand patients or with poor bone quality, cemented revision remains a good alternative treatment option.
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16
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Yamamuro Y, Kabata T, Kajino Y, Inoue D, Hasegawa K, Tsuchiya H. Does intraoperative periprosthetic occult fracture of the acetabulum affect clinical outcomes after primary total hip arthroplasty? Arch Orthop Trauma Surg 2022; 142:3497-3504. [PMID: 34677634 DOI: 10.1007/s00402-021-04226-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The frequency of intraoperative periprosthetic occult fracture of the acetabulum (IPOA) in primary total hip arthroplasty (THA) is relatively high. However, the effect of this fracture on clinical outcome and survival of primary THA remains unknown. This study aimed to determine the impact of IPOA on the outcomes of primary THA during a minimum follow-up of 5 years. MATERIALS AND METHODS This retrospective case-control study compared the outcomes of primary THA with or without IPOA during a minimum 5-year follow-up. Thirty-eight patients who underwent primary THA with IPOA (O group) were matched to 76 patients without IPOA (C group) between 2004 and 2013 based on age, sex, body mass index, primary diseases, cup diameter, cup design, and additional dome screw. Both groups underwent the same rehabilitation programs after surgery. We evaluated the Japanese Orthopaedic Association clinical outcomes score; postoperative complications, such as nerve injury, dislocation, heterotopic ossification, iliopsoas impingement, or infection; and radiographic outcomes. Additionally, we performed Kaplan-Meier survival analysis with cup aseptic loosening, cup failure revision, and all-cause revision as the endpoints. RESULTS There were no significant differences in the pre- and postoperative clinical scores, postoperative complication rates, and cup sagittal rotation between the two groups. Radiographic evaluations showed no aggravation of cases to overt fractures. Bone ingrowth was observed in all cases, and none of the acetabular cups had a progressive radiolucent line ≥ 2 mm in all the 3 acetabular zones. Ten-year survival rates for cup aseptic loosening and cup failure revision were 100% in both groups; those for all-cause revision were 97.4% (92.0-100%) and 100% in the O and C groups, respectively (p = 0.157). CONCLUSIONS Primary THA with IPOA provides favorable mid- to long-term outcomes. On IPOA diagnosis, although radiographic follow-up is necessary, additional treatments or rehabilitation programs are not required. Furthermore, postoperative computed tomography images for the detection of IPOA may be unnecessary.
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Affiliation(s)
- Yuki Yamamuro
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Takaramachi, 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Takaramachi, 13-1, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Takaramachi, 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Daisuke Inoue
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Takaramachi, 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuhiro Hasegawa
- Department of Orthopedic Surgery, Nanto Central Hospital, Nanto, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Takaramachi, 13-1, Kanazawa, Ishikawa, 920-8641, Japan
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17
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Periprosthetic Infection in the Setting of Periprosthetic Total Hip Fractures: Evaluation and Management. J Am Acad Orthop Surg 2022; 30:957-964. [PMID: 36200815 DOI: 10.5435/jaaos-d-21-00083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
The incidences of periprosthetic fracture and periprosthetic joint infection after total hip arthroplasty are expected to increase exponentially over the coming decades. Epidemiologic data suggest that many periprosthetic fractures after THA occur concurrently with a loose femoral implant. Recent studies suggest an approximately 8% incidence of indolent infection in cases of suspected aseptic loosening. The available data, therefore, suggest that periprosthetic fracture and infection may coexist, and this possibility should be considered, particularly in patients with a loose femoral stem and high pretest possibility. Although currently limited, the available literature provides some guidance as how to manage this complex issue.
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18
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[Effectiveness of shape memory alloy embracing device in treatment of Vancouver B2 periprosthetic femoral fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1244-1248. [PMID: 36310461 PMCID: PMC9626263 DOI: 10.7507/1002-1892.202204128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To analyze the effectiveness of shape memory alloy embracing device in the treatment of Vancouver B2 periprosthetic femoral fracture after primary hip arthroplasty. METHODS The clinical data of 30 patients (30 hips) with Vancouver B2 periprosthetic femoral fracture after primary hip arthroplasty between January 2019 and January 2021 were analyzed retrospectively. Among them, 15 cases were treated with shape memory alloy embracing device for fracture fixation (group A) and 15 cases with titanium cable cerclage (group B). There was no significant difference in general data such as gender, age, body mass index, the cause of primary arthroplasty and surgical method, prosthesis type, the cause and side of femoral fracture, the time from injury to operation, and comorbidities between the two groups ( P>0.05). The operation time, intraoperative blood loss, and hospital stay of the two groups were recorded. The fracture healing was examined by X-ray film, and the hip joint function was evaluated by Harris score. RESULTS The operations in both groups were completed successfully, and the incisions healed by first intention after operation with no vascular or nerve injury. The operation time and hospital stay in group A were significantly shorter than those in group B ( P<0.05), but there was no significant difference in intraoperative blood loss between group A and group B ( t=-0.518, P=0.609). Patients were followed up 12-20 months (mean, 16.3 months) in group A and 12-22 months (mean, 16.7 months) in group B. X-ray film showed that all fractures healed, the healing time was (14.73±2.05) weeks in group A and (17.27±2.60) weeks in group B, and there was a significant difference between the two groups ( t=-2.960, P=0.006). During follow-up, there was no complication such as prosthesis loosening, periprosthetic infection, joint stiffness, or internal fixator loosening. The Harris score of group A was significantly better than that of group B at 3, 6, and 12 months after operation ( P<0.05). CONCLUSION Compared with titanium cable cerclage, using shape memory alloy embracing device to fix Vancouver B2 periprosthetic femoral fracture can accelerate fracture healing, shorten operation time, and reduce intraoperative blood loss. Patients can perform functional exercise earlier and restore joint function better.
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19
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Takamura KM, McCarty CP, Ho NC, Diehl J, Longjohn DB, Ebramzadeh E, Sangiorgio SN. The insidious risk of periprosthetic fracture in clinically functional total hip arthroplasties: A biomechanical study of willed joints. J Orthop Res 2022; 40:1943-1952. [PMID: 34694639 DOI: 10.1002/jor.25203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/05/2021] [Accepted: 10/19/2021] [Indexed: 02/04/2023]
Abstract
Femoral bone quality is a major risk factor of periprosthetic fracture after total hip arthroplasty (THA), which has mortality similar to native hip fractures but higher short-term morbidity. The goal of this study was to quantify cortical strains at the site of expected Vancouver Type-B periprosthetic fracture as a function of bone mineral density, femoral stem material, and fixation method using a series of 29 autopsy-retrieved, clinically asymptomatic hip joints with THA. Periprosthetic bone mineral content and density was assessed using dual-energy X-ray absorptiometry by Gruen Zone. Specimens then underwent combined cyclic axial and torsional loading, increasing incrementally from 100 N and ±1 Nm to peaks of 700 N and ±5 Nm. All specimens experienced significantly higher strains on the lateral surface than on the anterior surface, indicating that the bending loads in the frontal plane, rather than axial/torsional loads, had the predominant effect. Multiple significant relationships (p = 0.04, p = 0.02) were found between predicted periprosthetic strains calculated from radiographic measurements and observed principal strains. Though THA in the present study were in successful clinical service, the produced results indicated that some femurs with rigid cemented or noncemented implants were potentially at high risk for Vancouver Type-B fractures, which may be predicted radiographically.
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Affiliation(s)
- Karren M Takamura
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Los Angeles Orthopaedic Center, University of California, Los Angeles, California, USA
| | - Colin P McCarty
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and the UCLA Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Nathan C Ho
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and the UCLA Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Jennifer Diehl
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and the UCLA Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Donald B Longjohn
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California Health Sciences Campus, Los Angeles, California, USA
| | - Edward Ebramzadeh
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Los Angeles Orthopaedic Center, University of California, Los Angeles, California, USA.,The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and the UCLA Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Sophia N Sangiorgio
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Los Angeles Orthopaedic Center, University of California, Los Angeles, California, USA.,The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and the UCLA Department of Orthopaedic Surgery, Los Angeles, California, USA
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20
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Lamb JN, Coltart O, Adekanmbi I, Pandit HG, Stewart T. Comparison of axial-rotational postoperative periprosthetic fracture of the femur in composite osteoporotic femur versus human cadaveric specimens: A validation study. Proc Inst Mech Eng H 2022; 236:973-978. [PMID: 35603754 PMCID: PMC9289970 DOI: 10.1177/09544119221092842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Postoperative periprosthetic femoral fracture following hip replacement has been the subject of many varied experimental approaches. Cadaveric samples offer realistic fit and fracture patterns but are subject to large between-sample variation. Composite femurs have not yet been validated for this purpose. We compared the results of composite femurs to cadaveric femurs using an established methodology. In vitro postoperative periprosthetic fracture results using axial-rotational loading were compared between 12 composite femurs and nine fresh frozen femurs, which were implanted with an otherwise identical collarless (6 composite vs 4 cadaveric) or collared (6 composite vs 5 cadaveric) cementless femoral stem using identical methodology. Fracture torque and rotational displacement were measured and torsional stiffness and rotational work prior to fracture were estimated. Fractures patterns were graded according to the Unified Classification System. Fracture torque, displacement, torsional stiffness and fracture patterns for cadaveric and composite femurs were similar between groups. There was a trend for a greater rotational displacement in the cadaveric groups, which lead to a decrease in torsional stiffness and a significantly greater rotational work prior to fracture for all cadaveric specimens (collarless stems: 10.51 [9.71 to 12.57] vs 5.21 [4.25 to 6.04], p = 0.01 and for collared stems: 15.38 [14.01 to 17.05] vs 5.76 [4.92 to 6.64], p = 0.01). Given comparable fracture torque and the similarity in fracture patterns for fracture trials using composite samples versus cadaveric femurs, the use of composite femur models may be a reasonable choice for postoperative periprosthetic femoral fracture studies within certain limitations.
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Affiliation(s)
- Jonathan N Lamb
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of medicine, University of Leeds, Leeds, UK
| | - Oliver Coltart
- School of Mechanical Engineering, University of Leeds, Leeds, UK
| | | | - Hemant G Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of medicine, University of Leeds, Leeds, UK
| | - Todd Stewart
- School of Mechanical Engineering, University of Leeds, Leeds, UK
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21
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Mondanelli N, Troiano E, Facchini A, Ghezzi R, Di Meglio M, Nuvoli N, Peri G, Aiuto P, Colasanti GB, Giannotti S. Treatment Algorithm of Periprosthetic Femoral Fracturens. Geriatr Orthop Surg Rehabil 2022; 13:21514593221097608. [PMID: 35573905 PMCID: PMC9096211 DOI: 10.1177/21514593221097608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction. The ever-expanding indications for total hip arthroplasty are leading to more implants being placed in younger as well as in older patients with high functional demand. Also, prolonged life expectancy is contributing to an overall increment of periprosthetic femoral fractures. The Vancouver classification has been the most used for guiding the surgeon choice since its proposal in 1995. Fractures occurring over a hip femoral implant can be divided into intra-operative and post-operative PFFs, and their treatment depends on factors that may severely affect the outcome: level of fracture, implant stability, quality of bone stock, patients’ functional demand, age and comorbidities, and surgeon expertise. There are many different treatment techniques available which include osteosynthesis and revision surgery or a combination of both. The goals of surgical treatment are patients’ early mobilization, restoration of anatomical alignment and length with a stable prosthesis and maintenance of bone stock. Significance. The aim of this review is to describe the state-of-the-art treatment and outcomes in the management of PFFs. We performed a systematic literature review of studies reporting on the management of PFFs around hip stems and inter-prosthetic fractures identifying 45 manuscripts eligible for the analysis. Conclusions. PFFs present peculiar characteristic that must be considered and special features that must be addressed. Their management is complex due to the extreme variability of stem designs, the possibility of having cemented or uncemented stems, the difficulty in identifying the “real” level of the fracture and the actual stability of the stem. As a result, the definition of a standardized treatment is unlikely, thereby high expertise is fundamental for the surgical management of PPFs, so this kind of fractures should be treated only in specialized centres with both high volume of revision joint arthroplasty and trauma surgery.
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Affiliation(s)
- Nicola Mondanelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy.,Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
| | - Elisa Troiano
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy.,Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
| | - Andrea Facchini
- Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia, Italy
| | - Roberta Ghezzi
- Ospedale Santa Maria degli Angeli, Azienda Sanitaria Friuli Occidentale, Italy
| | - Martina Di Meglio
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy.,Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
| | - Nicolò Nuvoli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy.,Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
| | - Giacomo Peri
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy.,Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
| | - Pietro Aiuto
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy.,Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
| | - Giovanni Battista Colasanti
- Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy.,Ospedale Santa Maria delle Croci, Azienda USL della Romagna, Italy
| | - Stefano Giannotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy.,Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
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22
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Schopper C, Luger M, Hipmair G, Schauer B, Gotterbarm T, Klasan A. The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) - a systematic review. BMC Musculoskelet Disord 2022; 23:280. [PMID: 35321671 PMCID: PMC8944079 DOI: 10.1186/s12891-022-05240-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Periprosthetic femoral fractures (PFFs) represent a major cause for surgical revision after hip arthroplasty with detrimental consequences for patients. The Vancouver classification has been traditionally used since its introduction in 1995. The Unified Classification System (UCS) was described in 2014, to widen the spectrum by aiming for a more comprehensive approach. The UCS also aimed to replace the Vancouver classification by expanding the idea of the Vancouver classification to the whole musculoskeletal apparatus. After introduction of the UCS, the question was raised, whether the UCS found its place in the field of analysing PFFs. Therefore, this systematic review was performed to investigate, the use of the UCS compared to the established Vancouver classification. Methods Medline was searched for reports published between 1 January 2016 and 31 November 2020, without language restriction. Included were original articles, irrespective of the level of evidence and case reports reporting on a PFF and using either the Vancouver or the UCS to classify the fractures. Excluded were reviews and systematic reviews. Results One hundred forty-six studies were included in the analysis. UCS has not been used in a single registry study, giving a pooled cohort size of 3299 patients, compared to 59,178 patients in studies using the Vancouver classification. Since 2016, one study using UCS was published in a top journal, compared to 37 studies using the Vancouver classification (p=0.29). During the study period, the number of yearly publications remained stagnant (p=0.899). Conclusions Despite valuable improvement and expansion of the latter UCS, to date, the Vancouver system clearly leads the field of classifying PFFs in the sense of the common use. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05240-w.
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Affiliation(s)
- Clemens Schopper
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria.
| | - Günter Hipmair
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Bernhard Schauer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Antonio Klasan
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
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23
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Tsai MH, Chen CC, Chang CH, Chang Y, Hsieh PH, Hu CC. Revision Total Hip Arthroplasty with Primary Stem or Full-Porous-Coated Long Stem for Aseptic Femoral Component Loosening: A Matched-Pair Study. Orthop Res Rev 2022; 14:25-33. [PMID: 35210872 PMCID: PMC8857999 DOI: 10.2147/orr.s346891] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background Revision total hip arthroplasty (RTHA) for loosening the femoral stem is a technical challenge. Distally fixed, full-porous-coated long stems are widely accepted as the standard selection for these revisions. However, the success of primary stems in RTHA is not well known. Methods This study enrolled 24 patients with aseptic loosening of the femoral stem who underwent RTHA using primary stems. Another 72 patients with aseptic loosening who underwent RTHA using full-porous-coated long stems were matched in terms of operation date, proximal femoral bone stock (Paprosky classification), sex, and age. The primary and secondary outcomes of failure were the need for revision for any reason and the radiographic change in the stem respectively. Results In the primary stem group, one patient had a periprosthetic fracture and received a second RTHA 2 years after the previous one. The primary outcome’s 5-and 10-year survival rates were both 95.8%. For the matched comparison group, one patient had an immediate periprosthetic fracture of the femoral shaft requiring further open reduction internal fixation surgery. Another patient had a full-porous-coated long stem breakage 6 years postoperatively, which required a second RTHA. The primary outcome’s 5-and 10-year survival rates were 98.6% and 97.2%, respectively. Conclusion Primary stems can achieve non-inferior clinical success compared to a full-porous-coated long stem for aseptic stem loosening RTHA in patients with adequate proximal femoral bone stock.
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Affiliation(s)
- Meng-Huan Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
| | - Chun-Chieh Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 33305, Taiwan
| | - Chih-Hsiang Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 33305, Taiwan
| | - Yuhan Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 33305, Taiwan
| | - Pang-Hsin Hsieh
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 33305, Taiwan
| | - Chih-Chien Hu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 33305, Taiwan
- Correspondence: Chih-Chien Hu, Bone and Joint Research Center, Chang Gung Memorial Hospital, Kweishan, Taoyuan, 33305, Taiwan, Tel +886-3-3281200, ext. 2420, Email
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Saemann M, Darowski M, Hennicke NS, Bader R, Sander M, Kluess D. Experimental analysis of early periprosthetic femoral fractures with uncemented straight hip stems. Clin Biomech (Bristol, Avon) 2022; 91:105543. [PMID: 34871913 DOI: 10.1016/j.clinbiomech.2021.105543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/15/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The periprosthetic femoral fracture is one of the most severe complications after total hip arthroplasty and is associated with an increased mortality. The underlying causes and the patient- and implant-specific risk factors of periprosthetic femoral fractures remain insufficiently understood. The aim of this study was to gain a more profound understanding of the underlying fracture mechanisms and to provide experimental datasets for validation of computational models. METHODS Six cadaveric femurs were implanted with straight hip stems (Zweymueller design) and loaded until fracture reproducing the clinically relevant load cases stumbling and sideways fall. Displacements and the strain distribution on the surface of the femurs and implants, as well as the fracture load and implant subsidence were measured. FINDINGS For the load case stumbling the mean fracture load was 6743 N and two different mechanisms leading to fracture could be identified: high subsidence with low femoral bending and small subsidence with high femoral bending. For the load case sideways fall the mean fracture load was 1757 N and both tested femurs fractured due to a rotation of the hip stem around its own axis. The detailed datasets provided by this study can be used in future computational models. INTERPRETATION We demonstrated that the underlying fracture mechanisms of periprosthetic femoral fractures can be fundamentally different in the load case stumbling. The seating and exact position of the hip stem in the femur may correlate with implant subsidence and therefore lead to different types of fracture mechanisms resulting in different patient-specific fracture risks.
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Affiliation(s)
- Michael Saemann
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany.
| | - Martin Darowski
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Nina S Hennicke
- Institute of Structural Mechanics, University of Rostock, Rostock, Germany
| | - Rainer Bader
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany
| | - Manuela Sander
- Institute of Structural Mechanics, University of Rostock, Rostock, Germany
| | - Daniel Kluess
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany
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Management of Vancouver B2 Periprosthetic Femoral Fractures, Revision Total Hip Arthroplasty Versus Open Reduction and Internal Fixation: A Systematic Review and Meta-Analysis. J Orthop Trauma 2022; 36:7-16. [PMID: 33942785 DOI: 10.1097/bot.0000000000002148] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify and analyze the current evidence for the use of open reduction and internal fixation (ORIF) constructs compared with conventional revision total hip arthroplasty (rTHA) for the management of Vancouver B2 periprosthetic femoral fractures (PFFs). DATA SOURCES A systematic literature search of the MEDLINE, CINAHL, and EMBASE databases was conducted. Prospective and retrospective studies were eligible. No limitation was placed on publication date, with only articles printed in English eligible. STUDY SELECTION Included studies were retrospective studies comparing ORIF and rTHA for the management of Vancouver B2 PFFs. DATA EXTRACTION The primary outcome was the overall complication rate. Other outcomes included as rate of dislocation, revision operation, refracture, infection, nonunion, and subsidence/loosening. Twenty-four studies were included totaling 1621 patients, of which 331 were treated with ORIF and 1280 with rTHA. CONCLUSION The 1621 patients included comprised a mixture of different fracture patterns, prostheses, and patient comorbidities. The overall complication rate for ORIF was 24% versus 18% for rTHA (P = 0.13). The results demonstrate that rTHA has a similar revision rate to ORIF in PFFs with a loose femoral component and adequate bone stock. ORIF was superior to rTHA in prevention of postoperative dislocation; however, there was no difference between other complications. This review suggests a potential role of both ORIF and rTHA in the management of Vancouver B2 PFFs. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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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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A Comparison of Risks and Benefits Regarding Hip Arthroplasty Fixation. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202111000-00001. [PMID: 34726640 PMCID: PMC8565793 DOI: 10.5435/jaaosglobal-d-21-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
Since the field-changing invention of noncemented hip arthroplasty fixation in the 1980s, noncemented fixation has been progressively replacing cemented fixation. However, analyses of fixation frequencies reveal new patterns in cement versus noncemented preferences. Although cementation is again gaining ground in the United States, noncemented models remain the dominant fixation mode, seen in more than 90% of all hip arthroplasties. This stark preference is likely driven by concerns regarding implant durability and patient safety. Although advances in surgical techniques, intensive perioperative care, and improved instrument have evolved in both methods, data from large arthroplasty registries reveal shifting risks in contemporary hip arthroplasty, calling the use of noncemented fixation into question. Varying risk profiles regarding sex, age, or health comorbidities and morphological and functional differences necessitate personalized risk assessments. Furthermore, certain patient populations, based on the literature and data from large registries, have superior outcomes from cemented hip arthroplasty techniques. Therefore, we wanted to critically evaluate the method of arthroplasty fixation in primary hip arthroplasties for unique patient populations.
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Miettinen HJ, Miettinen SS, Kettunen JS, Jalkanen J, Kröger H. Revision hip arthroplasty using a porous tantalum acetabular component. Hip Int 2021; 31:782-788. [PMID: 32312097 DOI: 10.1177/1120700020913294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Reconstruction of acetabulum in case of bone defects can be challenging. The aim of this retrospective study was to investigate the 10-year survival of trabecular tantalum metal (TM) acetabulum component in revision hip arthroplasty operations and to evaluate complications. METHODS A total of 100 consecutive acetabulum revision hip arthroplasties (100 patients) were operated on between May 2004 and October 2006 at Kuopio University Hospital. The mean follow-up time was 9.4 years and the median was 11.5 years (SD 4.118; range 0.1-13.4 years). Kaplan-Meier survival analysis was performed to study the survival of patients to re-revision surgery. Intra- and postoperative complications and reasons for re-revision were evaluated. RESULTS The Kaplan-Meier analysis showed a cumulative proportion of revision hip survivorship of 66% at 13.4 years (SE 0.403, 95% CI, 10.886-12.466) based on the need for further re-revision surgery for any major reason. The Kaplan-Meier survival analysis of time to re-revision surgery due acetabular component loosening showed a cumulative proportion of survivorship of 98.9% at 13.4 years (SE 0.136; 95% CI, 12.998-13.529). There were a total of 41/100 complications and the most common complication was dislocation (24/100). Re-revision for any major reason was performed on 18/100 of the revision arthroplasties. The mean time to re-revision was 4.9 years (SD 5.247; range 0.1-13.2 years). DISCUSSION The trabecular TM acetabular component gives excellent outcomes regarding stability and fixation to the acetabulum in acetabulum revision hip arthroplasty at a minimum of ten years of follow-up. However, acetabular component malposition and the small head size (28 mm) are risk factors for dislocation.
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Affiliation(s)
- Hannu Ja Miettinen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Pohjois-Savo, Finland
| | - Simo Sa Miettinen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Pohjois-Savo, Finland.,Faculty of Health Sciences, University of Eastern Finland, Kuopio, Pohjois-Savo, Finland
| | - Jukka S Kettunen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Pohjois-Savo, Finland
| | - Jussi Jalkanen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Pohjois-Savo, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Pohjois-Savo, Finland.,Faculty of Health Sciences, University of Eastern Finland, Kuopio, Pohjois-Savo, Finland
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Haider T, Hanna P, Mohamadi A, Merchan N, McNichol M, Wixted JJ, Appleton PT, Nazarian A, von Keudell AG, Rodriguez EK. Revision Arthroplasty Versus Open Reduction and Internal Fixation of Vancouver Type-B2 and B3 Periprosthetic Femoral Fractures. JBJS Rev 2021; 9:01874474-202108000-00009. [PMID: 34415859 DOI: 10.2106/jbjs.rvw.21.00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Revision arthroplasty (RA) continues to be considered the gold standard in the surgical treatment of Vancouver type-B2 and B3 periprosthetic femoral fractures. However, open reduction and internal fixation (ORIF) has been associated with satisfactory outcomes. Thus, there is an ongoing discussion regarding the optimal surgical strategy for the treatment of these fractures. » In this systematic review and meta-analysis, no significant differences in clinical and radiographic outcome were observed between ORIF and RA in the treatment of Vancouver type-B2 periprosthetic femoral fractures. » ORIF of Vancouver type-B3 periprosthetic femoral fractures was associated with higher revision and reoperation rates than those after RA. » Compared with RA, a significantly higher rate of subsidence was found in the ORIF group in Vancouver type-B2 periprosthetic femoral fractures whereas no significant difference in terms of loosening was observed. » In the comparison of RA and ORIF for the treatment of Vancouver type-B2 and B3 fractures, the percentage of patients achieving full weight-bearing did not differ significantly. » Mortality rates did not differ between RA and ORIF in the treatment of Vancouver type-B2 and B3 fractures. » Overall complication rates did not differ between RA and ORIF in the treatment of Vancouver type-B2 and B3 fractures. » We found a high heterogeneity in applied surgical and fixation techniques in the ORIF group.
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Affiliation(s)
- Thomas Haider
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Philip Hanna
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Amin Mohamadi
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Nelson Merchan
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Megan McNichol
- Knowledge Services Information Systems, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - John J Wixted
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Paul T Appleton
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
| | - Arvind G von Keudell
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward K Rodriguez
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
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De Cicco A, Toro G, Oliva F, Tarantino U, Schiavone Panni A, Maffulli N. Atypical periprosthetic femoral fractures of the hip: A PRISMA compliant systematic review. Injury 2021; 52:2407-2414. [PMID: 33810845 DOI: 10.1016/j.injury.2021.03.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Long-term use of bisphosphonates (BPs) is associated with Atypical Femoral Fracture (AFF). Theoretically, periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, recently several studies reported the occurrence of PPFs around a hip arthroplasty presenting features of an AFF. The present study describes the characteristics of Atypical Periprosthetic Femoral Fracture (APFF) and evaluates the effectiveness of their management through a PRISMA compliant systematic review of the published case reports and series. MATERIALS AND METHODS A literature search was performed using "periprosthetic fracture" and "atypical femoral fracture" as keywords. Patients demographics, drug use, clinical and imaging characteristics, stem fixation and classification, management strategies for APFF and patients' outcomes, were also collected. RESULTS The present review included and analysed 17 patients from 12 studies. All APFFs occurred in females with a mean age of 75.9 years of age (range 43-87). In 11 patients, APFFs occurred around an uncemented stem, and in 6 around a cemented stem. Ten fractures were incomplete, and 7 complete. Conservative management was effective in 4 of 10 patients with incomplete fracture, while all patients with complete fractures underwent open reduction and internal fixation. A fracture non-union was observed in 5 patients and further surgery was required. DISCUSSIONS APFFs share several clinical and imaging characteristics with AFF. An appropriate and early diagnosis may allow to improve the outcome of these fractures, the management of which should be based on the same principles of that of AFFs. CONCLUSIONS Considering the low quality of published articles and the heterogeneity of the treatment used, a clear recommendation of the most appropriate treatment cannot be formulated.
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Affiliation(s)
- Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", via L. De Crecchio 4, 80138, Naples, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", via L. De Crecchio 4, 80138, Naples, Italy; Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, viale Oxford, 00133, Rome, Italy
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Largo Città di Ippocrate 84131 Salerno, Italy.
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, viale Oxford, 00133, Rome, Italy.
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", via L. De Crecchio 4, 80138, Naples, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Largo Città di Ippocrate 84131 Salerno, Italy; Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Turner Street, Whitechapel, London, UK.
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Mondanelli N, Facchini A, Troiano E, Muratori F, Bottai V, Giannotti S. Periprosthetic Atypical Femoral Fractures Exist: A Retrospective Study at a Single Institution. Prevalence on 115 Periprosthetic Femoral Fractures Around a Primary Hip Stem. J Arthroplasty 2021; 36:2189-2196. [PMID: 33610412 DOI: 10.1016/j.arth.2021.01.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/19/2021] [Accepted: 01/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Some periprosthetic femoral fractures (PFFs) present history and radiographic aspect consistent with an atypical femoral fracture (AFF), fulfilling the criteria for AFF except that PFFs by themselves are excluded from the diagnosis of AFFs. The aim of this study is to evaluate in a single institution series of PFFs if any of them could be considered a periprosthetic atypical femoral fracture (PAFF), and their prevalence. METHODS Surgical records were searched for PFFs around a primary hip stem from January 2013 to December 2019. Cases were classified according to Vancouver classification. Demographic and medical history was extracted. Fisher's exact test was used for statistical analysis. RESULTS One hundred fifteen PFFs were identified, 59 of them were type B1 and 16 were type C. Radiographs and medical records were available for all patients. Twenty-four patients (32%) have been treated with bisphosphonates (BPs) for longer than 4 years. Four patients presented a fracture with characteristics of PAFF. When enlarged to all PFFs of the series, no other PAFF was found: prevalence of PAFFs was 5.3% for type B1 and C cases and 3.5% for all surgically treated PFFs. Statistical significative difference between PAFFs and PFFs was found for prolonged BP assumption and for the level of fracture clear of the stem. CONCLUSION Fracture with characteristics of AFFs can also happen over a prosthetic stem, configuring themselves as PAFFs, and they are related to prolonged BP use. As a correct diagnosis is mandatory for proper treatment, a revision of criteria for AFFs should be considered, accepting that PAFFs exist.
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Affiliation(s)
- Nicola Mondanelli
- Department of Medicine Surgery and Neurosciences, The Section of Orthopedics, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Andrea Facchini
- Department of Medicine Surgery and Neurosciences, The Section of Orthopedics, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Elisa Troiano
- Department of Medicine Surgery and Neurosciences, The Section of Orthopedics, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Francesco Muratori
- Department of Oncology, The Section of Orthopedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Vanna Bottai
- Department of Orthopedic and Trauma Surgery, Othopedic and Traumatology II, University of Pisa, Pisa, Italy
| | - Stefano Giannotti
- Department of Medicine Surgery and Neurosciences, The Section of Orthopedics, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
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Loucas M, Loucas R, Akhavan NS, Fries P, Dietrich M. Interprosthetic Femoral Fractures Surgical Treatment in Geriatric Patients. Geriatr Orthop Surg Rehabil 2021; 12:21514593211013790. [PMID: 34017616 PMCID: PMC8114290 DOI: 10.1177/21514593211013790] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Total hip (THA) and total knee arthroplasty (TKA) are becoming an increasingly standard procedure in the whole world. In conjunction with an aging population and increased prevalence of osteoporosis, proper management of periprosthetic, and interprosthetic fractures is of great interest to orthopedic surgeons. This study aims to report the clinical and radiographic outcomes, complications and reoperations of IFFs in geriatric patients. Methods A retrospective single-institution case series study was conducted. Between 2011 and 2019, 83 patients underwent surgical treatment for periprosthetic femoral fractures. Thirteen fractures were identified as IFFs. Patient demographics and comorbidities were collected preoperatively, and fractures were classified with the Vancouver and AO unified classification system (AO-UCS). Results We included 12 patients (13 hips) with IFFs (AO-UCS type IV.3 B (2/13) type IV.3 C (3/13), type IV.3 D (8/13)). The average patient age was 86.54 (range, 79-89) years. There were 10 females and 2 males. Perioperative morbidity has been identified in 10 of the 12 patients, and the 3-month and 1-year mortality were reported in 2 and 3 patients, respectively. Cerclage cables were used in 9 of 12 patients. One of 12 patients showed a local complication, with no documented implant failure or revision. Patients achieved complete union and returned to their preoperative ambulatory status, and full weight-bearing at an average of 5 (range, 2 to 7) months later. Conclusion Management of IFF can be challenging because these fractures require extensive surgical expertise. Locking plate seems to be a valuable treatment option for geriatric patients with IFFs. Despite the complexity of this type of fracture, the overall complication and revision rate, as well as the radiographic outcome are good to excellent. Level of Evidence Level III, Therapeutic study.
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Affiliation(s)
- Marios Loucas
- Department of Orthopedic Surgery, Handsurgery and Traumatology at City Hospital Waid and Triemli, Zurich, Switzerland.,Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Rafael Loucas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nico Safa Akhavan
- Department of Orthopedic Surgery, Handsurgery and Traumatology at City Hospital Waid and Triemli, Zurich, Switzerland
| | - Patrick Fries
- Department of Orthopedic Surgery, Handsurgery and Traumatology at City Hospital Waid and Triemli, Zurich, Switzerland
| | - Michael Dietrich
- Department of Orthopedic Surgery, Handsurgery and Traumatology at City Hospital Waid and Triemli, Zurich, Switzerland
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Fan MQ, Fan XH, Chen XL, Shen JJ, Jiang XJ, Li XS, Huang JF. The reliability and validity of the modified Unified Classification System for periprosthetic femoral fractures after hip arthroplasty. J Orthop Sci 2021; 26:385-388. [PMID: 32229162 DOI: 10.1016/j.jos.2020.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 11/21/2019] [Accepted: 03/12/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study assessed the reliability and validity of the modified Unified Classification System for femur fractures after hip arthroplasty. METHODS Four hundred and two cases were evaluated by 6 observers, 3 experts and 3 trainee surgeons. Each observer read the radiographs on 2 separate occasions and classified each case as to its type. Reliability was assessed by looking at the intraobserver and interobserver agreement using the Kappa statistic. Validity was assessed within the B group by looking at the agreement between the radiographic classification and the intraoperative findings. Interobserver and intraobserver agreement and validity were analyzed, using weighted kappa statistics. RESULTS The mean k value for interobserver agreement was found to be 0.882 (0.833-0.929) for consultants (almost perfect agreement) and 0.776 (0.706-0.836) for the trainees (substantial agreement). Intraobserver k values ranged from 0.701 to 0.972, showing substantial to almost perfect agreement. Validity analysis of 299 type B cases revealed 89.854% agreement with a mean k value of 0.849 (0.770-0.946) (almost perfect agreement). CONCLUSIONS This study has shown that the modified Unified Classification System is reliable and valid. We believe it is useful to improve the judgment of the implant stability, and establish the therapeutic strategy for periprosthetic femoral fracture.
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Affiliation(s)
- Meng-Qiang Fan
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China; The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China
| | - Xiao-Hong Fan
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao-Lei Chen
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jian-Jian Shen
- Department of Orthopaedics, Affiliated Cixi Hospital of Wenzhou Medical University, Cixi, China
| | - Xian-Jun Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China; The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China
| | - Xu-Song Li
- Department of Orthopaedics & Traumatology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, 528401, Guangdong, China
| | - Jie-Feng Huang
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China; The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China.
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Khwaja A, Mahoney W, Johnson J, Trompeter A, Lowe J. Biomechanics of periprosthetic femur fractures and early weightbearing. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:861-869. [PMID: 33852066 DOI: 10.1007/s00590-021-02969-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The incidence of periprosthetic fractures is expected to rise increase by 4.6% every 10 years between 2015 and 2060. There are few large series examining optimal fixation constructs or the influence of early ambulation on outcome. The purpose of this narrative review is to investigate the published biomechanical considerations for periprosthetic fracture fixation, with specific consideration of early postoperative weightbearing. METHODS A literature review was performed to identify fracture incidences, etiology, and current trends in weightbearing after fixation. Benefits of early weightbearing, current constructs, and biomechanics are reviewed. RESULTS The limited data available support medical benefits and increased union rates with early mobilization. Optimal fixation constructs are not agreed upon, but mechanical studies suggest that dual implant constructs can support physiologic weightbearing loads. CONCLUSION Further clinical trials are required to investigate fracture union and hardware complications in dual implant construct.
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Affiliation(s)
- Ansab Khwaja
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA.
| | - William Mahoney
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA
| | - Jay Johnson
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA.,Banner University Medical Group, Banner Health System Phoenix, Phoenix, AZ, USA
| | | | - Jason Lowe
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA.,Banner University Medical Group, Banner Health System Phoenix, Phoenix, AZ, USA
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Yun HH, Cheon SH, Im JT, Koh YY. Periprosthetic occult acetabular fracture: an unknown side effect of press-fit techniques in primary cementless total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1411-1419. [PMID: 33585969 DOI: 10.1007/s00590-021-02894-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 01/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study sought to investigate the prevalence and risk factors of periprosthetic occult acetabular fracture occurring during cementless acetabular cup insertion in patients undergoing primary total hip arthroplasty (THA) and to assess the clinical consequences of these fractures. METHODS A total of 232 hips (n = 205 patients) were included in this study. A periprosthetic occult acetabular fracture was defined as that which was unrecognised intraoperatively and was undetectable on post-operative radiographs yet was successfully diagnosed on post-operative computed tomography (CT) images. Clinical (age, sex, body mass index, and preoperative diagnosis) and surgical (additional screw fixation, cup rim size, and cup type) variables were analysed to identify risk factors for periprosthetic occult acetabular fracture. RESULTS Sixteen (6.9%) periprosthetic occult intraoperative acetabular fractures were identified. In addition, one (0.4%) periprosthetic acetabular fracture was found during operation. The superolateral wall (9/16 hips; 56.3%) was the most frequent location. In addition, one (0.4%) periprosthetic acetabular fracture was found during operation. Male sex was the only factor associated with an increased risk for periprosthetic occult intraoperative acetabular fracture (odds ratio for male versus female sex: 4.28; p = 0.04). There was no significant association between cup type and the occurrence of periprosthetic occult acetabular fracture. All 16 hips with periprosthetic occult intraoperative acetabular fracture were healed at the final follow-up visit without the requirement for any additional surgical interventions. CONCLUSION The results of the current study suggest that periprosthetic occult acetabular fractures are common during press-fit acetabular cup insertion in primary THA. Surgeons should have a high index of suspicion and early CT imaging referral in male patients who present with unexplained early post-operative groin pain in primary THA using cementless acetabular cups.
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Affiliation(s)
- Ho Hyun Yun
- Department of Orthopaedic Surgery, Veterans Healthcare Service Medical Center, Seoul, 134791, South Korea.
| | - Seung Hee Cheon
- Department of Orthopaedic Surgery, Veterans Healthcare Service Medical Center, Seoul, 134791, South Korea
| | - Jung Taek Im
- Department of Orthopaedic Surgery, Veterans Healthcare Service Medical Center, Seoul, 134791, South Korea
| | - Yeong Yoon Koh
- Department of Orthopaedic Surgery, Veterans Healthcare Service Medical Center, Seoul, 134791, South Korea
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Bissias C, Kaspiris A, Kalogeropoulos A, Papoutsis K, Natsioulas N, Barbagiannis K, Papagelopoulos PJ, Savvidou OD. Factors affecting the incidence of postoperative periprosthetic fractures following primary and revision hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:15. [PMID: 33407704 PMCID: PMC7788804 DOI: 10.1186/s13018-020-02152-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/09/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives The increasing number of hip arthroplasties (HA), due to the growing elderly population, is associated with the risk of femoral periprosthetic fractures (FPFs). The purpose of this study was to identify potential risk factors for the development of FPFs after HA. Methods A systematic review was conducted in five data bases (Medline, Embase, Cochrane, Cinahl, ICTRP) according to the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines up to May 2019, using the key words “risk factor,” “periprosthetic fracture,” and “hip replacement or arthroplasty.” Meta-analysis of the clinical outcomes of HA and subgroup analysis based on the factors that were implicated in FPFs was performed. Results Sixteen studies were included (sample size: 599,551 HA patients, 4253 FPFs, incidence 0.71%). Risk factors statistically associated with increased incidence of FPFs were female gender (+ 40%), previous revision arthroplasty surgery (× 3 times), and the presence of rheumatoid arthritis (× 2.1 times), while osteoarthritis (− 57%), cement application (− 59%), and insertion of Biomet (− 68%) or Thompson’s prosthesis (− 75%) were correlated with low prevalence of FPFs. Obesity, cardiac diseases, advanced age, bad general health (ASA grade ≥ 3), and use of Exeter or Lubinus prosthesis were not linked to the appearance of FPFs. Conclusion This meta-analysis suggested that female gender, rheumatoid arthritis, and revision arthroplasty are major risk factors for the development of FPFs after a HA. In those patients, frequent follow-ups should be planned. Further prospective studies are necessary to clarify all the risk factors contributing to the appearance of FPFs after HA. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-020-02152-0.
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Affiliation(s)
- Christos Bissias
- Department of Orthopaedic Surgery, Naval Hospital of Athens, Deinokratous 70, 115 21, Athens, Greece.
| | - Angelos Kaspiris
- Laboratory of Molecular Pharmacology/Division for Orthopaedic Research, School of Health Sciences, University of Patras, 26504, Patras, Greece
| | | | - Konstantinos Papoutsis
- Department of Orthopaedic Surgery, Naval Hospital of Athens, Deinokratous 70, 115 21, Athens, Greece
| | - Nikolaos Natsioulas
- Department of Orthopaedic Surgery, Naval Hospital of Athens, Deinokratous 70, 115 21, Athens, Greece
| | - Konstantinos Barbagiannis
- Department of Orthopaedic Surgery, Naval Hospital of Athens, Deinokratous 70, 115 21, Athens, Greece
| | - Panayiotis J Papagelopoulos
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, 124 62, Athens, Greece
| | - Olga D Savvidou
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, 124 62, Athens, Greece
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Pagani NR, Varady NH, Chen AF, Rajaee SS, Kavolus JJ. Nationwide Analysis of Lower Extremity Periprosthetic Fractures. J Arthroplasty 2021; 36:317-324. [PMID: 32826143 DOI: 10.1016/j.arth.2020.07.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the annual incidence of primary total joint arthroplasty is increasing, trends in the annual incidence of periprosthetic fractures have not been established. This study aimed to define the annual incidence of periprosthetic fractures in the United States. METHODS Inpatient admission data for 60,887 surgically treated lower extremity periprosthetic fractures between 2006 and 2015 were obtained from the National Inpatient Sample database. The annual incidence of periprosthetic fractures was defined as the number of new cases per year and presented as a population-adjusted rate per 100,000 US individuals. Univariable methods were used for trend analysis and comparisons between groups. RESULTS The national annual incidence of periprosthetic fractures presented as a population-adjusted rate of new cases per year peaked in 2008 (2.72; 95% confidence interval [95% CI], 2.39-3.05), remained stable from 2010 (1.65; 95% CI, 1.45-1.86) through 2013 (1.67; 95% CI, 1.55-1.8) and increased in 2014 (1.99; 95% CI, 1.85-2.13) and 2015 (2.47; 95% CI, 2.31-2.62). The proportion of femoral periprosthetic fractures managed with total knee arthroplasty revision remained stable (Ptrend = .97) with an increase in total hip arthroplasty (THA) revision (Ptrend < .001) and concurrent decrease in open reduction and internal fixation (ORIF) (Ptrend < .001). Revision THA was significantly more costly than revision total knee arthroplasty (P = .004), and both were significantly more costly than ORIF (P < .001 for both). CONCLUSION The annual incidence of periprosthetic fractures remained relatively stable throughout our study period. The proportion of periprosthetic fractures managed with revision THA increased, whereas ORIF decreased. Our findings are encouraging considering the significant burden an increase in periprosthetic fracture incidence would present to the health care system in terms of both expense and patient morbidity.
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Affiliation(s)
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sean S Rajaee
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joseph J Kavolus
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA
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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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Andriamananaivo T, Odri GA, Ollivier M, Mattesi L, Renault A, Rongieras F, Pesenti S, Severyns M. Contribution of the remaining attachment index in the management of Vancouver B1 periprosthetic hip fracture. Orthop Traumatol Surg Res 2020; 106:1413-1417. [PMID: 33055000 DOI: 10.1016/j.otsr.2020.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/28/2020] [Accepted: 06/17/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Implant fixation assessment following Vancouver B1 periprosthetic hip fracture is a major decision factor for internal fixation and/or implant revision. The main aim of the present study was to assess the correlation between radiographic Remaining Attachment Index (RAI) and risk of implant loosening at last follow-up following internal fixation of Vancouver B1 periprosthetic hip fracture. MATERIAL AND METHOD A multicentre retrospective study included 50 patients with Vancouver B1 periprosthetic hip fracture with uncemented femoral stem between 2013 and 2019. Preoperative radiographs were analysed independently by 2 senior orthopedic surgeons, distinguishing 2 groups: RAI>2/3 versus<2/3. Postoperative and last follow-up radiographs were then screened for signs of complete femoral component loosening. RESULTS Median age was 89 years (range: 36-99 years). Two RAI>2/3 patients showed implant loosening (8%) versus 9 RAI<2/3 patients (36%), disclosing a significant correlation between early loosening and RAI<2/3 (p=0.005). Interobserver agreement for both radiographic RAI and radiographic loosening assessment at last follow-up was 98% with kappa correlation coefficient 0.96 [range: 0.88-1]. CONCLUSION Remaining Attachment Index<2/3 in Vancouver B1 periprosthetic hip fracture was a risk factor for early implant loosening after isolated internal fixation. In these often frail elderly patients, first-line implant exchange is to be considered in the light of the risk/benefit ratio. The present results confirm the need for rigorous preoperative radiographic work-up of the remaining attachment area in Vancouver B1 fracture. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tsiry Andriamananaivo
- Service d'orthopédie et de traumatologie, centre hospitalier universitaire La Meynard de Martinique, CS 90632, 97261 Fort-de-France, Martinique
| | - Guillaume-Anthony Odri
- Service de chirurgie orthopédique et de traumatologie, CHU de Lariboisière, Paris, France
| | - Matthieu Ollivier
- Service de chirurgie orthopédique et traumatologique, hôpital Sainte-Marguerite, CHU de Marseille, Marseille, France
| | - Lucas Mattesi
- Service d'orthopédie et de traumatologie, centre hospitalier universitaire La Meynard de Martinique, CS 90632, 97261 Fort-de-France, Martinique
| | - Arthur Renault
- Service d'orthopédie et de traumatologie, centre hospitalier universitaire La Meynard de Martinique, CS 90632, 97261 Fort-de-France, Martinique
| | - Frédéric Rongieras
- Service de chirurgie orthopédique et traumatologique, hôpital Édouard-Herriot, Lyon, France
| | - Sébastien Pesenti
- Service de chirurgie orthopédique et traumatologique, hôpital Sainte-Marguerite, CHU de Marseille, Marseille, France
| | - Mathieu Severyns
- Service d'orthopédie et de traumatologie, centre hospitalier universitaire La Meynard de Martinique, CS 90632, 97261 Fort-de-France, Martinique.
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Stoffel K, Horn T, Zagra L, Mueller M, Perka C, Eckardt H. Periprosthetic fractures of the proximal femur: beyond the Vancouver classification. EFORT Open Rev 2020; 5:449-456. [PMID: 32818072 PMCID: PMC7407870 DOI: 10.1302/2058-5241.5.190086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The majority of periprosthetic femoral fractures are treated surgically. Surgical treatment may be revision only, revision in combination with open reduction and internal fixation (ORIF), or ORIF only. The treatment decision is dependent on whether the stem is loose or not, but loose stems are not always identified, resulting in unsatisfactory treatments. This article presents an algorithmic approach to identifying loose stems around proximal femoral periprosthetic fractures, taking patient history, stem design, and plain radiographs into consideration. This approach may help identifying loose stems and increase the probability of effective treatments.
Cite this article: EFORT Open Rev 2020;5:449-456. DOI: 10.1302/2058-5241.5.190086
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Affiliation(s)
- Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Tamara Horn
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Luigi Zagra
- Hip Department, IRCCS Galeazzi Orthopaedic Institute, Milano, Italy
| | - Michael Mueller
- Orthopaedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Perka
- Orthopaedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Henrik Eckardt
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
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De Meo D, Zucchi B, Castagna V, Pieracci EM, Mangone M, Calistri A, Persiani P, Villani C. Validity and reliability of the Unified Classification System applied to periprosthetic femur fractures: a comparison with the Vancouver system. Curr Med Res Opin 2020; 36:1375-1381. [PMID: 32468914 DOI: 10.1080/03007995.2020.1776232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The Unified Classification System (UCS) presents itself as an evolution of the Vancouver Classification (VCS) for the evaluation of periprosthetic fractures of the proximal femur (PPF). The aim of our study was to highlight any loss of reproducibility or validity of the new classification system, compared to the previous one.Material and methods: We tested the interobserver and intraobserver agreement using 40 PPF clinical cases. Each classifying subtype of the UCS and VCS was present in at least two cases. Six experienced hip surgeons (Senior Surgeon, SS) and 5 surgeons in training (Junior Surgeon, JS) classified the clinical cases, using VCS and UCS. The validity of both classifications was then tested with intraoperative surveys.Results: The mean κ value for interobserver agreement for the VCS in the JS group was 0.65 and 0.81 for the SS group. The mean κ value for interobserver agreement for the UCS in the JS group was 0.63 and 0.65 for the SS group. The mean κ value for intraobserver agreement for the VCS in the JS group was 0.71 and 0.73 for the SS group. The mean κ value for intraobserver agreement for the UCS in the JS group was 0.72 and 0.7 for the SS group. Validity analysis showed a moderate agreement for the VCS and a good agreement for the UCS.Conclusion: The UCS completes the Vancouver classification, expanding it. It is reliable, despite the increase in classification categories and number of parameters to evaluate, with a slightly higher validity.
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Affiliation(s)
- Daniele De Meo
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
- Department of Orthopaedics and Traumatology, Policlinico Umberto I, Rome, Italy
| | - Benedetta Zucchi
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
- Department of Orthopaedics and Traumatology, Policlinico Umberto I, Rome, Italy
| | - Valerio Castagna
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
- Department of Orthopaedics and Traumatology, Policlinico Umberto I, Rome, Italy
| | - Edoardo M Pieracci
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
- Department of Orthopaedics and Traumatology, Policlinico Umberto I, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
| | - Alessandro Calistri
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
- Department of Orthopaedics and Traumatology, Policlinico Umberto I, Rome, Italy
| | - Pietro Persiani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
- Department of Orthopaedics and Traumatology, Policlinico Umberto I, Rome, Italy
| | - Ciro Villani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
- Department of Orthopaedics and Traumatology, Policlinico Umberto I, Rome, Italy
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Strauss AC, Koob S, Jansen TR, Wirtz DC. [Periprosthetic fractures of the proximal femur]. Chirurg 2020; 91:804-812. [PMID: 32504105 DOI: 10.1007/s00104-020-01209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The incidence of periprosthetic fractures of the proximal femur is increasing due to the growing numbers of hip replacements in old age. The treatment of these fractures is a challenge for the treating physician and standardized procedures are necessary. The unified classification system (UCS) is a suitable tool to establish treatment strategies: On the basis of the fracture localization and extent, bone quality, stability of the prosthesis and the presence of further implants, the fractures can be classified according to the UCS and a treatment algorithm can be derived. This article gives an overview of the diagnostics, classification and characteristics of the various periprosthetic fracture types as well as the treatment.
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Affiliation(s)
- A C Strauss
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - S Koob
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - T R Jansen
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - D C Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Affiliation(s)
- Fares S. Haddad
- The Bone & Joint Journal, Professor of Orthopaedic Surgery, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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Has the Use of Fixation Techniques in THA Changed in This Decade? The Uncemented Paradox Revisited. Clin Orthop Relat Res 2020; 478:697-704. [PMID: 31899744 PMCID: PMC7282602 DOI: 10.1097/corr.0000000000001117] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite existing studies favoring cemented fixation for patients older than 75 years, a trend toward increased use of uncemented fixation has been described in a 2013 study that used arthroplasty registry data from 2006 to 2010. Updated summarized data are needed beyond 2010 to investigate contemporary trends in the usage of uncemented fixation, especially in patients older than 75 years, and to draw attention to a potential continuing conflict between trends in fixation choice and reported revision risk. Thus, healthcare policy and practice can change and surgeons can make better implant fixation choices. QUESTIONS/PURPOSES (1) Has the percentage of primary THAs performed with uncemented fixation changed since 2010? (2) Has the percentage of primary THAs performed in patients older than 75 years performed with uncemented fixation changed since 2010? (3) After stratifying by age, which fixation strategy (cemented versus uncemented and hybrid versus uncemented) is associated with the lowest risk of revision? METHODS National annual reports from hip arthroplasty registers were identified, and data were extracted from registers published in English or a Scandinavian language, with at least 3 years of reported data in the period from 2010 to 2017. These included Australia, Denmark, England-Wales, Finland, the Netherlands, New Zealand, Romania, Norway, Sweden, and Switzerland, which are all countries with high completeness rates. Data regarding rates of revisions (all causes) related to fixation methods and secondary to different age groups, were taken directly from the registers and no re-analysis was done. The risk estimates were presented as either hazard ratios, rate per 100 component years or as Kaplan-Meier estimates of revision. The age groups compared for Denmark were younger than 50, 50-59, 60-69,70-79, and older than 80 years, and for Australia, New Zealand, England-Wales, and Finland, they were younger than 55, 55-64, 65-74, and older than 75 years. No data were pooled across the registers. RESULTS The current use of uncemented fixation in primary THAs varies between 24% (Sweden) and 71% (Denmark). Increasing use of uncemented fixation has been reported in Norway, Denmark, and Sweden, whereas decreasing use of uncemented fixation has been reported in England-Wales, Australia, New Zealand, and Finland. Examining the group of patients older than 75 years, we found that the use of uncemented fixation has been stable in Netherlands, Sweden, New Zealand, and England-Wales. The use of uncemented fixation is still increasing in Denmark and Australia. In Finland, the use of uncemented fixation has decreased (from 43 % to 24 %) from 2010 to 2017. When compared with uncemented fixation, the risk of revision for hips using cemented fixation was lower in patients older than 75 years for all registers surveyed, except for the oldest males in the Finnish register. In this group, no difference was found between cemented and uncemented fixation. CONCLUSION Our findings should be used in healthcare policy as feedback on current THAs being performed so as to direct surgeons to choose the right implant fixation, especially in patients older than 75 years, thereby reducing revision risk and increasing the long-term survival of primary THAs. It appears that femoral stem fixation may be the most important revision risk factor in older patients, and future studies should examine this perspective. LEVEL OF EVIDENCE Level III, therapeutic study.
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Carpenter CVE, Wylde V, Moore AJ, Sayers A, Blom AW, Whitehouse MR. Perceived occurrence of an adverse event affects patient-reported outcomes after total hip replacement. BMC Musculoskelet Disord 2020; 21:118. [PMID: 32085754 PMCID: PMC7035750 DOI: 10.1186/s12891-020-3127-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/10/2020] [Indexed: 11/14/2022] Open
Abstract
Background Dislocation, periprosthetic fracture and infection are serious complications of total hip replacement (THR) and which negatively impact on patients’ outcomes including satisfaction, quality of life, mental health and function. The accuracy with which patients report adverse events (AEs) after surgery varies. The impact of patient self-reporting of AEs on patient-reported outcome measures (PROMs) after THR is yet to be investigated. Our aim was to determine the effect of confirmed and perceived AEs on PROMs after primary THR. Methods A prospective single-centre cohort study of patients undergoing primary THR, with one-year follow-up, was performed. Participants completed forms pre-operatively and 3, 6, 9 and 12 months post-operatively, including Work Productivity and Activity Impairment (WPAI), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol-5D-3 L (EQ5D), Self-Administered Patient Satisfaction (SAPS) and AE reporting questionnaires. Results were reported in three groups: No AE, reported but not confirmed AE and confirmed AE. A generalised linear model was used to compare among groups using robust standard errors (SE). Results Forty-one AEs were reported in a cohort of 417 patients (234 females), with 30 AEs reported by 3 months. Eleven (27 reported) infections, two (six reported) periprosthetic fractures and two (eight reported) dislocations were confirmed. Those in the no AE group reported significantly better outcomes that the reported AE group as measured by WOMAC Co-Eff 14.27 (p = 0.01), EQ5D − 0.128 (p = 0.02) and SAPS − 9.926 (p = 0.036) and the combined reported and confirmed AE groups as measured by WOMAC Co-Eff 13.72 (p = 0.002), EQ5D − 0.129 (p = 0.036) and SAPS − 11.512 (p = 0.004). No significant differences were seen in WPAI among groups. Conclusions Patients who report AEs have worse outcomes than those who do not, regardless of whether the AEs can be confirmed by standard medical record review methods. The observed negative trends suggest that patient perception of AEs may influence patient outcome in a similar way to those with confirmed AEs.
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Affiliation(s)
- Charlotte V E Carpenter
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Andrew J Moore
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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Treatment of Complex Femoral Fractures with the Long Intramedullary Gamma Nail. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2018-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The purpose of the current study was to present the authors’ experiences with the long intramedullary Gamma nail in the treatment of patients with complex femoral fractures. Th is retrospective study included 48 patients with complex femoral fractures. All patients had received fracture fixation treatments with long intramedullary Gamma nails from January 2007 to December 2015. The complex fractures of all patients were classified into 3 types, according to the anatomical locations of the fractures. Type I included combined fractures of the shaft and the proximal femur. Type II included segmental fractures. Type III included combined fractures of the shaft and distal femur. According to the Harris Hip Score, 85.4% of our patients had excellent and very good functional outcomes of the operative procedure. Complications occurred in 7 (14.58%) patients. The most common complications occurred in patients with combined fractures of the shaft and distal femur (50%). Based on the findings of this study, we conclude that the clinical and radiological results after the treatment of complex femoral fractures with the long intramedullary Gamma nail show good outcomes, with a high rate of bone union and minimal soft tissue damage. Experience with this procedure is important to prevent and minimise technical complications.
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Chakrabarti D, Thokur N, Ajnin S. Cable plate fixation for Vancouver Type-B1 periprosthetic femoral fractures-Our experience and identification of a subset at risk of non-union. Injury 2019; 50:2301-2305. [PMID: 31630783 DOI: 10.1016/j.injury.2019.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Management of periprosthetic femoral fractures is challenging. Vancouver classification is universally accepted for fracture description and management algorithm. Guidelines for the treatment of type B1 fracture is open reduction and internal fixation. The difficulty involved in managing this group is evidenced by the array of treatment options described in the literature. METHODS Thirty two patients with Vancouver type B1 fracture treated with osteosynthesis using cable plate (between 2007 and 2015) were reviewed retrospectively. There were 21 females and 11 males with an average age of 81yrs (56-96 years). The average follow-up was 21 months. All patients were reviewed clinically and radiologically until fracture united or patient re-operated. Postoperative protocol followed was six weeks toe touch weight bearing, 6 weeks partial weight bearing and then full weight bearing if there was no displacement. Post-operative radiographs were evaluated for fracture union. Statistical analysis was done using contingency tables with Fishers exact test and a p-value < 0.05 for significance. RESULTS In twenty four patients fracture union was achieved. Non-union was recorded in four patients. Comparing the different fracture patterns all non-unions occurred in the fractures which were short oblique or transverse at the cemented stem tip (p = 0.001). Fractures were more common in female patients and associated more with the uncemented femoral stems, but it was not associated with increased rate of non-union (p = 0.68). All failed osteosynthesis were revised successfully using long stem prosthesis. Two patients died within 2 months, one patient died within 4 months, one patient was lost to follow-up. CONCLUSION Transverse or short oblique periprosthetic fractures around tip of cemented femoral stems can have high failure rates with just internal fixation. Revision arthroplasty may be the preferred option if possible otherwise may need to supplement fixation with cortical onlay graft. We should consider subcategorising Vancouver type B1 periprosthetic fractures into groups based on the pattern and fracture level in relation to the femoral stem.
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Affiliation(s)
- Dip Chakrabarti
- MS Orth, MRCS, MRCS, Dip SEM, FRCS(Tr & Orth), Pg Cert Med Ed, University Hospital Birmingham NHS Foundation Trust, United Kingdom.
| | - Niyamathullah Thokur
- Department of Trauma & Orthopaedics, University Hospital Birmingham NHS Foundation Trust
| | - Serajdin Ajnin
- Department of Trauma & Orthopaedics, University Hospital Birmingham NHS Foundation Trust
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Lamb JN, Matharu GS, Redmond A, Judge A, West RM, Pandit HG. Risk Factors for Intraoperative Periprosthetic Femoral Fractures During Primary Total Hip Arthroplasty. An Analysis From the National Joint Registry for England and Wales and the Isle of Man. J Arthroplasty 2019; 34:3065-3073.e1. [PMID: 31353251 DOI: 10.1016/j.arth.2019.06.062] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/24/2019] [Accepted: 06/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study is to estimate risk factors for intraoperative periprosthetic femoral fractures (IOPFF) and each anatomic subtype (calcar crack, trochanteric fracture, femoral shaft fracture) during primary total hip arthroplasty. METHODS This retrospective cohort study included 793,823 primary total hip arthroplasties between 2004 and 2016. Multivariable regression modeling was used to estimate relative risk of patient, surgical, and implant factors for any IOPFF and for all anatomic subtypes of IOPFF. Clinically important interactions were assessed using multivariable regression. RESULTS Patient factors significantly increasing the risk of fracture were female gender, American Society of Anesthesiologists grade 3 to 5, and preoperative diagnosis including avascular necrosis of the hip, previous trauma, inflammatory disease, pediatric disease, and previous infection. Overall risk of IOPFF associated with age was greatest in patients below 50 years and above 80 years. Risk of any fracture reduced with computer-guided surgery and in non-National Health Service hospitals. Nonposterior approaches increased the risk of shaft and trochanteric fracture only. Cementless implants significantly increased the risk of only calcar cracks and shaft fractures and not trochanteric fractures. CONCLUSION Fracture risk increases in patients younger than 50 and older than 80 years, females, American Society of Anesthesiologists grade 3 to 5, and indications other than primary osteoarthritis. Large cumulative reduction in IOPFF risk may occur with use of cemented implants, posterior approach, and computer-guided surgery. LEVEL OF EVIDENCE Level 3b (cohort study).
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Affiliation(s)
- Jonathan N Lamb
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom; Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Gulraj S Matharu
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| | - Anthony Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom; Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| | - Robert M West
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Hemant G Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom; Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom; Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
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Deng Y, Kieser D, Wyatt M, Stringer M, Frampton C, Hooper G. Risk factors for periprosthetic femoral fractures around total hip arthroplasty: a systematic review and meta-analysis. ANZ J Surg 2019; 90:441-447. [PMID: 31617684 DOI: 10.1111/ans.15473] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Periprosthetic fractures are becoming increasingly common, often leading to poor patient outcomes. The aim of this study was to identify risk factors associated with periprosthetic femoral fractures (PPFFx). METHODS Two independent reviewers conducted a systematic review of the databases MEDLINE, Embase and Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, from the earliest available date to December 2017. We included all clinical articles reporting more than 100 post-operative PPFFx around total hip arthroplasty (THA). Outcomes included demographics, fracture type, risk factors and time to fracture. RESULTS A total of 12 868 PPFFx were reported across 18 eligible studies; 64% occurred following primary THA and 36% occurred after revision THA, and 66% of all fractures were in females. Vancouver B2 fractures were the most common type (39%). We found the odds of sustaining a PPFFx is significantly lower after a primary THA compared to revision THA (odds ratio 0.31, 95% confidence interval 0.24-0.40, P < 0.00001). The incidence of PPFFx is 2.96 per 1000 person-years following primary THA compared to 9.08 per 1000 person-years following revision THA (odds ratio 0.33, 95% confidence interval 0.27-0.40). The time to fracture was 6.03 years following primary THA and 4.08 years following revision THA. Gender and cementation did not significantly affect the odds of fracture. CONCLUSION The odds of sustaining a PPFFx following revision THA is three times greater compared to primary THA. Other risk factors including gender and cementation did not affect the odds of fracture.
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Affiliation(s)
- Yi Deng
- Department of Orthopaedic, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - David Kieser
- Department of Orthopaedic, Christchurch Hospital, Christchurch, New Zealand.,Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | - Michael Wyatt
- Department of Orthopaedic Surgery, Palmerston North Hospital, Palmerston North, New Zealand
| | - Mark Stringer
- Department of Orthopaedic, Christchurch Hospital, Christchurch, New Zealand
| | - Christopher Frampton
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | - Gary Hooper
- Department of Orthopaedic, Christchurch Hospital, Christchurch, New Zealand.,Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
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Tibbo ME, Wyles CC, Fu S, Sohn S, Lewallen DG, Berry DJ, Maradit Kremers H. Use of Natural Language Processing Tools to Identify and Classify Periprosthetic Femur Fractures. J Arthroplasty 2019; 34:2216-2219. [PMID: 31416741 PMCID: PMC6760992 DOI: 10.1016/j.arth.2019.07.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/18/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Manual chart review is labor-intensive and requires specialized knowledge possessed by highly trained medical professionals. The cost and infrastructure challenges required to implement this is prohibitive for most hospitals. Natural language processing (NLP) tools are distinctive in their ability to extract critical information from unstructured text in the electronic health records. As a simple proof-of-concept for the potential application of NLP technology in total hip arthroplasty (THA), we examined its ability to identify periprosthetic femur fractures (PPFFx) followed by more complex Vancouver classification. METHODS PPFFx were identified among all THAs performed at a single academic institution between 1998 and 2016. A randomly selected training cohort (1538 THAs with 89 PPFFx cases) was used to develop the prototype NLP algorithm and an additional randomly selected cohort (2982 THAs with 84 PPFFx cases) was used to further validate the algorithm. Keywords to identify, and subsequently classify, Vancouver type PPFFx about THA were defined. The gold standard was confirmed by experienced orthopedic surgeons using chart and radiographic review. The algorithm was applied to consult and operative notes to evaluate language used by surgeons as a means to predict the correct pathology in the absence of a listed, precise diagnosis. Given the variability inherent to fracture descriptions by different surgeons, an iterative process was used to improve the algorithm during the training phase following error identification. Validation statistics were calculated using manual chart review as the gold standard. RESULTS In distinguishing PPFFx, the NLP algorithm demonstrated 100% sensitivity and 99.8% specificity. Among 84 PPFFx test cases, the algorithm demonstrated 78.6% sensitivity and 94.8% specificity in determining the correct Vancouver classification. CONCLUSION NLP-enabled algorithms are a promising alternative to manual chart review for identifying THA outcomes. NLP algorithms applied to surgeon notes demonstrated excellent accuracy in delineating PPFFx, but accuracy was low for Vancouver classification subtype. This proof-of-concept study supports the use of NLP technology to extract THA-specific data elements from the unstructured text in electronic health records in an expeditious and cost-effective manner. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Sunyang Fu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Sunghwan Sohn
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Hilal Maradit Kremers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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