Atypical periprosthetic femoral fractures of the hip: A PRISMA compliant systematic review

Cicco, Annalisa De; Toro, Giuseppe; Oliva, Francesco; Tarantino, Umberto; Panni, Alfredo Schiavone; Maffulli, Nicola

doi:10.1016/j.injury.2021.03.042

Cited by 10 publications

(12 citation statements)

References 35 publications

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“…Concerning the treatment of incomplete APFFs, our findings demonstrated the high failure rate of conservative treatment, which is comparable to the results from a systematic review by De Cicco et al [ 8 ]. In the previous study, the effectiveness of conservative treatment and prophylactic fixation in the incomplete APFFs was 40% (4 in 10) and 83% (5 in 6), respectively [ 8 ].…”

Section: Discussionsupporting

confidence: 89%

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Atypical Periprosthetic Femoral Fracture Associated With Prolonged Bisphosphonate Therapy: A Two-Centered Retrospective Case Series and Literature Review

Sabsuantang¹,

Chotanaphuti²,

Wongsak³

et al. 2022

Cureus

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To date, atypical periprosthetic femoral fractures (APFFs) are not well-understood due to a relatively small number of studies on the topic. Moreover, there is a paucity of guidance regarding the appropriate treatment strategy. We would therefore like to present and analyze a series of five APFF cases (one incomplete APFF and four complete APFFs) that were treated in two university hospitals; a review of the literature is also provided. The results provide additional and useful information regarding the treatment strategy for APFFs.

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Section: Discussionsupporting

confidence: 89%

“…Regarding patient characteristics, the findings from this study were mostly comparable to the previous studies that have larger sample sizes [ 5 - 8 ] (Table 2 ). Our data showed that the APFF patients had common demographic data, such as being female, using long-term bisphosphonates, and having a Vancouver B1 fracture pattern.…”

Section: Discussionsupporting

confidence: 87%

Atypical Periprosthetic Femoral Fracture Associated With Prolonged Bisphosphonate Therapy: A Two-Centered Retrospective Case Series and Literature Review

Sabsuantang¹,

Chotanaphuti²,

Wongsak³

et al. 2022

Cureus

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“…THA in this population are associated with a high risk of life-threatening complications including dislocations, thromboembolism, infections and periprosthetic fractures (PPF) [16,[18][19][20]. One of the most relevant factors that could influence the outcomes of the THA in the elderly with FNF is the poor bone quality [21].…”

Section: Discussionmentioning

confidence: 99%

SuperPath approach is a recommendable option in frail patients with femoral neck fractures: a case–control study

Cecere

Cicco

Bruno

et al. 2021

Arch Orthop Trauma Surg

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Introduction The treatment of intracapsular femoral neck fractures (FNFs) in the elderly is usually based on hip replacement, both total hip arthroplasty (THA) and hemiarthroplasty (HA). Recently, several tissue-sparing approaches for hip arthroplasty had been described with promising results in terms of hospitalization length, blood loss and dislocation rate. The aim of the present study was to compare the blood loss and the transfusion rate in a cohort of patients with FNF treated using an HA through both the SuperPath (SP) and the traditional posterolateral (PL) approaches. Materials and methods We retrospectively collected data from patients affected by FNFs between January 2018 and February 2020. All patients with intracapsular FNF treated with a single HA implant (Profemur L, MicroPort Orthopedics Inc., USA) via PL or SP approaches were included. Exclusion criteria were pathological fractures, polytrauma and preoperatively transfused patients. Results Thirty-five patients were included and analysed in the present study. 17 patients were classified in the SP group, and 18 in the PL one. The rate of antithrombotic therapy was higher in the SP group compared with the PL group [10 (58, 82%) vs 4 (22, 2%)]. While the two groups did not differ in terms of preoperative haemoglobin (Hb), 48 h postoperative Hb and Hb reduction, a significative difference was observed in terms of blood transfusion rate (1 SP vs 9 PL, p = 0.0072). Conclusions The SuperPath approach in patients with FNF under antithrombotic therapy assures lower transfusion rate, potentially reducing complication rates and improving patients' outcomes.

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“…However, there are a number of published studies suggesting that periprosthetic atypical femoral fractures (PAFFs) can occur and should not be excluded by definition. 18 - 42 Subsequently, PAFFs could be considered as a subset of PFFs that present AFFs’ features. 21 , 36 Unfortunately, the lack of data available on this topic does not allow the development of precise diagnostic criteria to identify PAFFs in order to avoid misdiagnosis.…”

Section: Definitionmentioning

confidence: 99%

“…Surgery should even be considered if the patient shows one of the following characteristics: contralateral previous fracture, presence of an uncemented stem and severe symptoms. 33 , 36 Complete PAFFs should be treated surgically, paying attention to the high rotational instability of the fracture. In this case, the addition of a medial strut graft may enhance fixation stability and outcomes.…”

Section: Definitionmentioning

confidence: 99%

Surgical and Pharmacological Management of Periprosthetic Atypical Femoral Fractures: A Narrative Literature Review

Troiano

Giacché

Facchini

et al. 2022

Geriatr Orthop Surg Rehabil

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Introduction An increasing number of patients is annually undergoing total hip arthroplasty (THA), and a significant proportion of these patients are elderly and consequently at a higher risk of complications because of age, osteoporosis, and medical comorbidities. Periprosthetic femoral fractures (PFFs) are one of the worst complications of THA associated with high rates of unfavorable prognosis. Besides, in the last decade, a new independent disease entity called “atypical femoral fracture” (AFF) has been identified and defined by the American Society for Bone and Mineral Research (ASBMR) task force. Some PFFs present clinical history and radiographic aspect consistent with an AFF, meeting the ASBMR criteria for the diagnosis of AFF except that PFFs by themselves are an exclusion criterion for AFF. However, there is an increasing number of published studies suggesting that periprosthetic atypical femoral fractures (PAFFs) exist and should not be excluded by definition. Significance Nowadays, although there is an increasing interest in PAFFs, there are still very few studies published on the topic and a lack of consensus regarding their treatment. This narrative literature review aims to introduce this new emerging topic to a wider readership describing the characteristics of PAFFs and the state-of-the-art in their management. Conclusions Many authors agree that PAFFs should be considered as a subgroup of PFFs that have atypical characteristics; they also show a significant correlation with prolonged bisphosphonate use. A correct diagnosis is paramount for proper treatment of the disease that requires both surgical and medical actions to be taken.

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Atypical periprosthetic femoral fractures of the hip: A PRISMA compliant systematic review

Cited by 10 publications

References 35 publications

Atypical Periprosthetic Femoral Fracture Associated With Prolonged Bisphosphonate Therapy: A Two-Centered Retrospective Case Series and Literature Review

Atypical Periprosthetic Femoral Fracture Associated With Prolonged Bisphosphonate Therapy: A Two-Centered Retrospective Case Series and Literature Review

SuperPath approach is a recommendable option in frail patients with femoral neck fractures: a case–control study

Surgical and Pharmacological Management of Periprosthetic Atypical Femoral Fractures: A Narrative Literature Review

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