Mortality After Periprosthetic Fracture of the Femur

Bhattacharyya, Timothy; Chang, Denis; Meigs, James B.; Estok, Daniel M.; Malchau, Henrik

doi:10.2106/jbjs.f.01538

Cited by 343 publications

(229 citation statements)

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“…Extrapolating these results to those of the comparison between nonperiprosthetic distal femur fractures and hip fractures, it could be inferred periprosthetic distal femur fractures likely carry a higher mortality risk than hip fractures. Bhattacharyya et al [4] found similar mortality rates between patients with hip fractures and those with periprosthetic fractures of the femur about THA stems. Although this in contrast to our results, of their periprosthetic fracture cohort of 106 patients, only 32 were classified as having Vancouver Type C fractures, which, in some instances, could have been distal femur fractures.…”

Section: Discussionmentioning

confidence: 90%

“…Mortality rates at 30 days, 6 months, and 1 year after surgery were 6%, 18%, and 25%, respectively ( Table 1). The five patients who died during the first 30 days had an average age of 85.3 years (range, 76-94 years) and an average CCI of 4 (range, [3][4][5][6][7][8]. One 86-year-old patient with a history of prostate cancer and mitral valve repair (CCI, 3) died while in the hospital owing to pneumonia, respiratory failure, and sepsis.…”

Section: Resultsmentioning

confidence: 99%

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Mortality After Distal Femur Fractures in Elderly Patients

Streubel

Ricci

Wong

et al. 2011

Clinical Orthopaedics &Amp; Related Research

245

163

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Background Hip fractures in the elderly are associated with high 1-year mortality rates, but whether patients with other lower extremity fractures are exposed to a similar mortality risk is not clear. Questions/purposes We evaluated the mortality of elderly patients after distal femur fractures; determined predictors for mortality; analyzed the effect of surgical delay; and compared survivorship of elderly patients with distal femur fractures with subjects in a matched hip fracture group. Patients and Methods We included 92 consecutive patients older than 60 years with low-energy supracondylar femur fractures treated between 1999 and 2009. Patient, fracture, and treatment characteristics were extracted from operative records, charts, and radiographs. Data regarding mortality were obtained from the Social Security Death Index. Results Age-adjusted Charlson Comorbidity Index and a previous TKA were independent predictors for decreased survival. Congestive heart failure, dementia, renal disease,

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Section: Discussionmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Mortality After Distal Femur Fractures in Elderly Patients

Streubel

Ricci

Wong

et al. 2011

Clinical Orthopaedics &Amp; Related Research

245

163

View full text Add to dashboard Cite

show abstract

“…Although periprosthetic fracture is a relatively rare complication affecting less than 5% of all hip arthroplasties [3,8,10], it is associated with increased morbidity and mortality compared with aseptic revision surgery [6,14,19,20,31], decreased functional return, and substantial cost to the individual and society. Treatment usually requires open reduction and internal fixation with a wide exposure (wellfixed stem) or a difficult revision arthroplasty (loose stem) with or without allograft struts/bone grafting [16].…”

Section: Introductionmentioning

confidence: 99%

Does Femoral Component Loosening Predispose to Femoral Fracture?: An In Vitro Comparison of Cemented Hips

Harris

Owen

Wayne

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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The incidence of femur fracture around total hip arthroplasties continues to increase at substantial cost to society. These fractures are frequently associated with a loose femoral component. Consequently, we sought to test whether femoral component loosening predisposes to periprosthetic femoral fracture. Because many periprosthetic femoral fractures are spiral in nature, we evaluated the torsional characteristics of the implanted femur in which the only design variable was instability of the femoral component. We used synthetic (polyurethane) (n = 15) and paired cadaveric femora (n = 10) with specimens divided into two groups: well-fixed and loose cemented stems. Each specimen was tested mechanically in internal rotation until failure. For the synthetic specimens, torque to failure was reduced by 38%, whereas stiffness was decreased 54% for the loose group compared with the well-fixed group. For the cadaveric specimens, torque to failure was reduced by 58%, whereas stiffness decreased 70% for the loose group compared with the wellfixed group. Fracture patterns were similar between synthetic and cadaveric femora with a proximal spiral pattern in loose specimens and more distal fracture patterns with well-fixed stems. Based on our data, patients with loosened femoral components are at risk for fracture at a substantially lower torque than those with well-fixed components.

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“…Besides, even if it is a radical reconstruction method, it seems a valid alternative for treating the complication of arthroplasties (generally of the hip although also of the knee) where other solutions apart from amputation would imply long bed rest periods [7,19].…”

Section: Discussionmentioning

confidence: 99%

Total Femoral Replacement in Non-Neoplastic Disorders

Vedoya¹

2017

MOJOR

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Submit Manuscript | http://medcraveonline.com IntroductionThe deficit of femoral bone stock is a frequent finding. This situation is mostly derived from the increased number of hip and knee arthroplasties and the consequent increase of failed implants, periprosthetic fractures and infections. There are other non-tumoral causes that generate this type of deficit, such as hardware failures in pathological bone, osteomielytis, congenital bone defects and metabolic bone diseases, etc [1-3].Several solutions have been proposed, which must be analyzed depending on the cause and magnitude of the femoral and acetabular bone loss, the patient's muscle status (particularly the gluteus medius), the presence of infection, the age and background of the patient, and, of course, the surgeon's expertise and his surgical facilities. This last aspect is essential, as revision and conversion surgeries are very demanding, for both patient and surgeon.The most frequent alternatives include the use of cemented or non cemented long femoral stems, with proximal or distal fixation, associated or not to bone graft. Many studies have referred to the advantages and disadvantages of each of these treatment alternatives [2][3][4]. Nevertheless, in certain cases, the femoral bone deficit is so significant that there is not enough bone to properly fix any of these revision implants. In these patients, an option is the total hip replacement with a megaprosthesis, and among them, the total femur replacement (TFR) [4][5][6][7][8][9].Buchman was the first to report a total femur replacement in a patient with Paget´s disease 10 . The first total femur implants were made of hip and knee prosthesis united by a polyethylene shaft, to which these components were adapted [5,10]. Even if this was a low cost versatile design, in time it was observed that polyethylene alone was not an adequate material to bear the load and torsions at a femoral level, particularly in young patients with high functional demand, since most of the initial patients were operated due to tumours [4]. In the mid 80s, modularity revolutionized reconstruction prosthesis, allowing the surgeon to estimate the existing bone defect, and therefore select the appropriate components for more accurate reconstructive surgery [1,11].The good outcome of patients treated with TFR for neoplastic causes widened the indication of this treatment to patients with massive femoral bone loss due to several non-neoplastic causes, not being the estimated survivorship of the patient an excluding factor in the decision process [12]. However, except for the publications from Endo-Klinik in Hamburg, Germany, which exceed 100 cases [7], the rest of TFR reports in non-neoplastic pathology analyze around 20 cases at the most. Additionally, in all these series the pre-operative diagnosis is varied, making it difficult to obtain from them a clear conclusion on the evolution of these patients on the medium and long term. In this study we evaluate the indications, surgical technique and post operative care of TFR ...

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Mortality After Periprosthetic Fracture of the Femur

Cited by 343 publications

References 20 publications

Mortality After Distal Femur Fractures in Elderly Patients

Mortality After Distal Femur Fractures in Elderly Patients

Does Femoral Component Loosening Predispose to Femoral Fracture?: An In Vitro Comparison of Cemented Hips

Total Femoral Replacement in Non-Neoplastic Disorders

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