Effect of Fracture Type, Treatment, and Surgeon Training on Reoperation After Vancouver B Periprosthetic Femur Fractures

Toci, Gregory R.; Stambough, Jeffrey B.; Martin, John R.; Mears, Simon C.; Saxena, Arjun; Lichstein, Paul M.; Jordan, Eric H.; Egan, Cameron; Chen, Antonia F.; Erens, Greg A.; Chabib, Samir; Wall, Bryce; Fernando, Navin; Nichols, Jordan; Schwarzkopf, Ran; Lygrisse, Katherine A.; Amanatullah, Derek F.; Arora, Prerna; Ivanov, David; Loughran, Galvin J.; Browne, James A.; Hogarth, Danielle A.; Hudson, Parke; Donaldson, Thomas; Buttacavoli, Frank; Kari, Ravi; Mills, Galen

doi:10.1016/j.arth.2023.03.024

Cited by 6 publications

(2 citation statements)

References 25 publications

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“…Fixation or revision arthroplasty for a periprosthetic fracture is equally challenging and, often, the decision-making depends on surgeon expertise, implant availability and patient factors. Although the studies in this review do not expand and correlate these variables to their outcomes, Toci et al [ 48 ] reported that surgeon experience exerts a significant influence on reoperation rates in revision for Vancouver B fractures.…”

Section: Discussionmentioning

confidence: 99%

Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis

Sahemey,

Ridha,

Stephens

et al. 2024

Arthroplasty

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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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Section: Discussionmentioning

confidence: 99%

Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis

Sahemey,

Ridha,

Stephens

et al. 2024

Arthroplasty

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“…Interestingly, when reviewing the relationship between surgeon experience in pediatric surgeries across multiple surgical specialties, including orthopedic surgery, neurosurgery, otolaryngology, and cardiothoracic surgery, Rhee et al reported that the improved mortality outcomes seen following general and cardiothoracic surgeries by pediatric-trained surgeons did not extend to the field of orthopedic surgery [ 6 ]. Even in adult studies, the effects of surgeon type and training on surgical outcomes remain unclear [ 18 ]. A study by Silva et al, however, demonstrated how the increased pediatric surgical experience was found to significantly reduce the need for open reduction and percutaneous pinning in the treatment of supracondylar humerus fractures, but they note that multiple factors likely influence this assertion [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Hip Dysplasia Surgery Outcomes by Pediatric Versus Nonpediatric Orthopedists

Dance,

Quan,

Parel

et al. 2024

Cureus

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Objectives Developmental dysplasia of the hip (DDH) encompasses a spectrum of abnormalities in the immature hip. Surgical intervention is indicated if conservative management fails. Despite the increased supply of pediatric orthopedic surgeons (POSs) over the last few decades, there continues to be a maldistribution of surgeons. The purpose of this study is to determine outcomes following surgical management of hip dysplasia by POSs compared to non-pediatric orthopedic surgeons. Methods Pediatric patients who underwent surgical treatment for hip dysplasia from 2012 to 2019 were identified using a large national database. Patient demographics, comorbidities, and postoperative complications were compared by pediatric versus nonpediatric-trained orthopedic surgeons. Bivariate and multivariable regression analyses were performed. Results Of the 10,780 pediatric patients who underwent hip dysplasia surgery, 10,206 patients (94.7%) were operated on by a POS, whereas 574 (5.3%) were operated on by a non-pediatric orthopedic surgeon. POSs were more likely to operate on patients with a higher American Society of Anesthesiologists class (p<0.001) and those with a greater number of medical comorbidities, including cardiac (p=0.001), gastrointestinal (p=0.017), and neurological (p<0.001). Following analysis using multivariable regression models to control for patient baseline characteristics, there were no differences in any postoperative complications between patients treated by pediatric-trained and nonpediatric-trained orthopedic surgeons. Conclusions Compared to non-pediatric orthopedic surgeons, POSs were more likely to operate on younger patients with increased medical comorbidities. However, there were no differences in postoperative complications following surgical management for DDH in patients treated by nonpediatric and pediatric orthopedic surgeons.

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Stem revision vs. internal fixation in Vancouver B2/B3 periprosthetic hip fractures: systematic review and metanalysis

Di Martino,

Brunello,

Villari

et al. 2024

Arch Orthop Trauma Surg

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Introduction Vancouver B2 and B3 periprosthetic fractures (PFF) are associated with stem instability and often require a demanding stem implant revision (SR) or internal fixation (ORIF). This latter surgery is increasingly performed in the last few years instead of SR, but it is unclear which is the best treatment to manage PFF patients. The aim of this study is the compare the outcomes of B2/B3 PFF managed by either ORIF or SR, by performing a systematic review and meta-analysis of current literature. Materials and methods Cochrane Database, PubMed, Google Scholar and MEDLINE were examined to find out relevant publications dealing with the different outcomes of SR vs. ORIF in B2/B3 PFF of the hip. The effect model (EM) was calculated using Cohen´s d index. Results Fifteen studies were included, reporting on a total of 1629 patients (564 ORIF and 1065 SR). The pooled random EM estimates for reoperation was 0.87 (95% CI, 0.39–1.96; I2 = 78%) in favor of ORIF surgery; EM for complications was 1.01 (95% CI, 0.45–2.27; I2 = 85%) without difference among procedures. The EM for transfusion was 0.72 (95% CI, 0.46–1.12; I2 = 62%) in favor of fixation. Conclusion ORIF and SR were both suitable and effective options in PFF patients, being associated to similar complications rates. Our results show that ORIF performance in PFF patients is associated to significantly less in blood loss, surgical time and in-hospital stay. These advantages are particularly appealing in patients with multiple comorbidities.

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Effect of Fracture Type, Treatment, and Surgeon Training on Reoperation After Vancouver B Periprosthetic Femur Fractures

Cited by 6 publications

References 25 publications

Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis

Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis

Pediatric Hip Dysplasia Surgery Outcomes by Pediatric Versus Nonpediatric Orthopedists

Stem revision vs. internal fixation in Vancouver B2/B3 periprosthetic hip fractures: systematic review and metanalysis

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