Periprosthetic femoral fractures associated with hip arthroplasty

Correlations between Vancouver type of periprosthetic femur fracture and treatment outcomes

Objective

Periprosthetic femur fractures are one of the most severe complications of total hip arthroplasty.

Methods

The aim of this study was to assess outcomes of periprosthetic femur fractures based on the Vancouver classifications of fractures.

Results

Sixty-four patients were enrolled into the study. Type B1 fractures were the most common - 33 cases. In comparison to patients with type B3 fracture, patients with type B1 fracture significantly less often experienced postoperative pain.

Conclusion

Study shown that in the context of both objective outcomes of the operation and patient satisfaction, the most unfavourable prognosis is after type B3.

Curative treatment of prosthetic joint infection in patients younger than 80 vs. 80 or older

OBJECTIVE

Prosthetic joint infection (PJI) is a serious complication of joint replacement surgery. The major pharmacological and surgical treatments required by PJI increase the risk of peri-operative complications in elderly patients. The increase in life expectancy combined with procedural advances make these treatments possible even in the oldest patients. Here, our objective was to compare the characteristics and outcomes of curative PJI treatment in patients < 80 years vs. ≥ 80 years.

METHODS

A prospective single-center design was used to compare the characteristics and outcomes of curative treatment for hip or knee PJI in patients < 80 years and ≥ 80 years admitted in 2004-2014.

RESULTS

Of 765 patients admitted for PJI, 590 were < 80 years and 124 were ≥ 80 years. Medical history and comorbidities were similar in the two groups. The older group had a significantly higher proportion of patients with American Society of Anesthesiologists Scores ≥ 3 and with streptococcal infection (20% vs. 13%, P < 0.05). After complete surgical excision and prolonged antibiotic therapy, the only event whose frequency differed significantly between the two groups was PJI-related death, which was more common in the older patients (6.5% vs. 0.8%, P < 0.05). The 2-year survival rate after one-stage exchange arthroplasty was > 90% in the  ≥80 year group.

CONCLUSION

Patients aged 80 years or older are eligible for the same curative pharmacological and surgical PJI treatments used in their younger counterparts. Before surgery, the risk/benefit ratio of the major surgical procedure required to treat PJI must be assessed on a case-by-case basis.

Periprosthetic Femoral Fractures in the Emergency Department: What the Orthopedic Surgeon Wants to Know

Femoral fracture in the setting of a hip arthroplasty is an increasingly common complication encountered in the emergency department (ED). Diagnosis and management of periprosthetic fractures are complicated, and orthopedic surgeons rely on imaging findings to guide the appropriate management approach to the injury. Delay in identification and appropriate definitive management of periprosthetic fractures is associated with high morbidity and mortality. At present, the Vancouver classification system for periprosthetic hip fractures is the most common classification system used by orthopedic surgeons. It relies on three radiographic criteria-fracture location, prosthesis stability, and quality of the femoral bone stock-to characterize these fractures and to help guide management decisions. Familiarly with the Vancouver classification system allows radiologists to both recognize and communicate the most clinically relevant imaging findings to the treating orthopedic surgeon. This article reviews the imaging workup for hip pain in patients with a femoral prosthesis, risk factors for periprosthetic fracture, and the expected normal appearance of the most commonly encountered types of femoral prostheses. Fracture terminology and the Vancouver classification system are reviewed in a simplified algorithm with emphasis on the most common patterns of periprosthetic fractures, the radiologic determinants of prosthesis stability and bone quality, and the management implications of these imaging findings. Finally, multiple instructive clinical cases are used to demonstrate critical application of the classification system and to highlight the clinical implications of the imaging findings. ^©RSNA, 2017.

Is immediate weight bearing safe for periprosthetic distal femur fractures treated by locked plating? A feasibility study in 52 consecutive patients

Background

Periprosthetic distal femur fractures associated with total knee replacement are increasing in incidence. We hypothesized that a standardized management protocol would result in few implant failures and a low rate of postoperative complications.

Methods

Retrospective observational cohort study at an urban level 1 trauma center and academic level 2 trauma center. Consecutive patients with periprosthetic distal femur fractures and stable total knee arthroplasty were included between January 1, 2011 and December 31, 2014. Patients were managed by a standardized protocol of co-management by a hospitalist service, fracture fixation within 24 h of admission by less-invasive locked bridge plating, and immediate unrestricted postoperative weight bearing. The primary outcome measure was the rate of postoperative complications. Secondary outcome measures included time to surgery, intraoperative blood loss, duration of surgery, length of hospital stay, time to full weight bearing, and time to radiographic fracture healing.

Results

Fifty four fractures were treated in 52 patients. There were three implant failures, one deep infection, one nonunion and two patients with symptomatic malunion. One patient had knee pain due to patellar component instability associated with valgus alignment. There were ten thromboembolic complications despite consistent anticoagulation. Two patients died within 12 months of injury. Thirty-eight patients had returned to their pre-injury ambulation status at 1 year follow-up.

Conclusion

A standardized approach of less-invasive locked plating fixation and immediate unrestricted weight bearing appears safe and feasible in the management of this vulnerable patient cohort.

Trial registration number

This is a retrospective observational study without a Trial registration number.

Periprosthetic Femur Fracture Occuring after Contralateral Neglected Femoral Neck Fracture

Introduction:

Periprosthetic fractures of the femur are uncommon, but at times may lead to complications especially in elderly patients. As treatment of these fractures is difficult, prevention by identifying the risk factors is the best way to overcome these complex problems.

Case Report:

A periprosthetic right femur fracture associated with a neglected left femoral neck fracture in the contralateral femur in a 78-year-old elder woman patient is reported in the present article. We discuss the prevention of periprosthetic fractures after hip arthroplasty and address the risk factors associated with this complication.

Conclusion:

The present case emphasizes the importance of investigating and treating the cause of sudden onset of restriction on full weight-bearing in the contralateral limb, to prevent periprosthetic femoral fracture after hip arthroplasty in elderly patients.

Periprosthetic femoral fracture - an interdisciplinary challenge

BACKGROUND

The increasing implantation rates of total hip and knee prostheses have been accompanied by a corresponding rise in periprosthetic fractures (PPF), most often affecting the femur.

METHOD

This review is based on a selective search of the PubMed database for articles in English and German. The search was carried out with a set of pertinent medical subject headings (MeSH) and as a free text search employing a logical combination of search terms (evidence grade III-IV).

RESULTS

Soft-tissue-sparing, stable-angle plate osteosynthesis with a firmly seated implant is a safe treatment of periprosthetic femoral fracture (PPFF). A correct assessment of the stability of the prosthesis is a prerequisite for the success of treatment. A loose prosthesis must be surgically revised, and a failed osteosynthesis can also necessitate revision of the prosthesis. The conservative management of PPFF is generally not indicated, as it has a high complication rate.

CONCLUSION

The treatment of periprosthetic fractures requires competence, not just in osteosynthetic techniques, but also in endoprosthesis implantation and revision. Careful preoperative planning to select the proper treatment is essential, and the necessary equipment must be on hand.