Periprosthetic femoral fractures in Total Hip Arthroplasty (THA): a comparison between osteosynthesis and revision in a retrospective cohort study

Abstract

Background Periprosthetic femoral fractures are challenging complications of hip arthroplasty. They are supposed to be a rare complication, but their incidence is rapidly increasing. Surgical treatment aims to achieve early mobilization and avoid the complications of prolonged bed rest. Aim of this study is to evaluate the clinical outcomes of surgical treatment comparing two surgical approaches: revision arthroplasty (RA) versus open reduction and internal fixation (ORIF). Methods Authors retrospectively reviewed a series of 117 patients with total hip arthroplasty treated for periprosthetic femur fractures in the period between January 2013 and March 2018 at a single tertiary referral center. Of these, 70 patients satisfied strict inclusion criteria. Patients were classified according to the Unified Classification System (UCS) and distributed in two groups according to surgical treatment. Clinical outcomes were assessed using the Oxford Hip recorded preoperatively and post operatively, Barthel Score, CIRS score (Cumulative illness rating scale), type of fracture and post-operative complications with a minimum follow up of 1 year. Results Nominal univariate statistical analysis revealed significant differences between the post and pre-operative Oxford Hip Score (Δ Oxford) and the surgical treatment (p = 0.008) and CIRS score (p = 0.048). Moreover, we observed a significant relationship between type of treatment and type of fracture (p = 0.0001). Multivariate analyses revealed that CIRS score was independently associated with Oxford Score improvement after surgery (p = 0.024). Conclusions Data from this case series confirmed that surgical treatment was correlated to type of fracture, according to UCS classification. Patients treated by RA had a better functional outcome than patients treated with ORIF, but these results are strongly influenced from the patients’ age, Barthel index and CIRS score. Also, authors found a correlation between functional outcome and comorbidities evaluated by CIRS score. Based on these data we suggest a multimodal approach to these patients, like those used for proximal femoral fractures.

Mid-term results of a cementless hip stem in femoral revision: how much diaphyseal press-fit do we need?

“…Despite this complex setting, the patient satisfaction with the surgical results was generally high at 97.7%. The OHS at follow-up was 37.3, which was comparable to a reported OHS of 32 after fractures reported by Scalici et al [ 11 ], of 34 at two-year follow-up reported by Willems et al [ 12 ], of 32.07 at six years follow-up by Abdelsamie et al [ 1 ], or 34 after five years by Lequeuche et al [ 13 ] in revision THA.…”

Influence of Scan Parameters of Single and Dual-Energy CT Protocols in Combination with Metal Artifact Suppression Algorithms for THA

“…Because lysis of the bone-implant interface, a potential sign of septic or aseptic loosening, may occur after any duration of implantation, the time that the selected specimens had been in situ ranged from 1.8 to 307.1 months, in order to represent a broad range of bone ingrowth stages. The mean age of the donors was 86 ± 7.2 years, which is comparable to the reported peak of periprosthetic fractures in the average population at a mean age of 88 years 16 . Each femur was exarticulated and was stored at −20°C.…”

“…Each hip stem had been implanted during the person's lifetime, and thus represented the actual bone-implant interface for the first time. Furthermore, the included prostheses displayed different stages of osseointegration, and the mean donor age was similar to the peak of periprosthetic fractures 16 . We found that the best overall protocol in terms of subjective image quality was the SE protocol with a tin filter and iMAR.…”

Open Reduction and Internal Fixation for Vancouver B1 and B2 Periprosthetic Femoral Fractures: A Proportional Meta-Analysis

“…Many studies have reported noninferior outcomes of ORIF for management of B2 PFFs, with the advantage of a shorter operating time, lower blood transfusion rate, and overall fewer complications 26 48) . For example, ORIF, which can preserve the existing implant and provide good functional outcomes, may be preferred in treatment of stable B2 fractures with a good bone stock and minimal implant loosening 49 50 51) . Thus, there is potential for selection bias in the included studies reporting outcomes of ORIF in Vancouver B2 PFFs 44 45 46) .…”