Abstract:The Vancouver classification is still a useful tool of communication and stratification of periprosthetic fractures, but besides the three parameters it considers, clinicians should also assess additional factors. Combined advanced trauma and arthroplasty skills must be available in departments managing these complex injuries. Preoperative confirmation of the THA (total hip arthroplasty) stability is sometimes challenging. The most reliable method remains intraoperative assessment during surgical exploration o… Show more
“…Our initial search provided 2156 articles and, after applying inclusion and exclusion criteria we identified a total of 49 studies. 8 - 10 , 33 , 35 - 79 Figure 1. Flow chart representing the search strategy for the articles included in the review according to PRISMA guidelines.…”
Section: Methodsmentioning
confidence: 99%
“…Double structural grafts placed perpendicular to each other (anterior and lateral cortex) or a combination of structural graft and a plate can be useful to augment bone stock. 36 , 50 , 65 Cortical onlay structural grafts increase cortical strength and have shown good clinical results, and they can also be used prophylactically. 65 Even if cerclage fixation can appear sufficient to provide fracture stability, a long stem bypassing the fracture by 2 cortical diameters is necessary to achieve axial stability ( Figure 5 ).…”
Section: Methodsmentioning
confidence: 99%
“…The goals of surgical treatment are restoration of anatomical alignment and length with a stable prosthesis, maintenance or enhancement of bone stock, early mobilisation and early union. 12 , 35 , 36 , 50 , 71 Intramedullary (revision stems or nails in type C PFFs) or extramedullary (plates, cerclages, structural graft) techniques, or a combination of both, are used to achieve these goals ( Table 4 ). The correct management of the fracture is dictated by the stability of the femoral implant: if the stem remains well-fixed the fracture can be treated with osteosynthesis, otherwise revision of the implant must be considered.…”
Section: Methodsmentioning
confidence: 99%
“… 22 , 39 , 80 , 101 However, there are cases in which patients are not suitable for surgery from a medical and anaesthesiologic point of view, therefore conservative treatment remains the only possible option. 8 , 9 , 35 , 36 , 66 , 69 …”
Introduction. The ever-expanding indications for total hip arthroplasty are leading to more implants being placed in younger as well as in older patients with high functional demand. Also, prolonged life expectancy is contributing to an overall increment of periprosthetic femoral fractures. The Vancouver classification has been the most used for guiding the surgeon choice since its proposal in 1995. Fractures occurring over a hip femoral implant can be divided into intra-operative and post-operative PFFs, and their treatment depends on factors that may severely affect the outcome: level of fracture, implant stability, quality of bone stock, patients’ functional demand, age and comorbidities, and surgeon expertise. There are many different treatment techniques available which include osteosynthesis and revision surgery or a combination of both. The goals of surgical treatment are patients’ early mobilization, restoration of anatomical alignment and length with a stable prosthesis and maintenance of bone stock. Significance. The aim of this review is to describe the state-of-the-art treatment and outcomes in the management of PFFs. We performed a systematic literature review of studies reporting on the management of PFFs around hip stems and inter-prosthetic fractures identifying 45 manuscripts eligible for the analysis. Conclusions. PFFs present peculiar characteristic that must be considered and special features that must be addressed. Their management is complex due to the extreme variability of stem designs, the possibility of having cemented or uncemented stems, the difficulty in identifying the “real” level of the fracture and the actual stability of the stem. As a result, the definition of a standardized treatment is unlikely, thereby high expertise is fundamental for the surgical management of PPFs, so this kind of fractures should be treated only in specialized centres with both high volume of revision joint arthroplasty and trauma surgery.
“…Our initial search provided 2156 articles and, after applying inclusion and exclusion criteria we identified a total of 49 studies. 8 - 10 , 33 , 35 - 79 Figure 1. Flow chart representing the search strategy for the articles included in the review according to PRISMA guidelines.…”
Section: Methodsmentioning
confidence: 99%
“…Double structural grafts placed perpendicular to each other (anterior and lateral cortex) or a combination of structural graft and a plate can be useful to augment bone stock. 36 , 50 , 65 Cortical onlay structural grafts increase cortical strength and have shown good clinical results, and they can also be used prophylactically. 65 Even if cerclage fixation can appear sufficient to provide fracture stability, a long stem bypassing the fracture by 2 cortical diameters is necessary to achieve axial stability ( Figure 5 ).…”
Section: Methodsmentioning
confidence: 99%
“…The goals of surgical treatment are restoration of anatomical alignment and length with a stable prosthesis, maintenance or enhancement of bone stock, early mobilisation and early union. 12 , 35 , 36 , 50 , 71 Intramedullary (revision stems or nails in type C PFFs) or extramedullary (plates, cerclages, structural graft) techniques, or a combination of both, are used to achieve these goals ( Table 4 ). The correct management of the fracture is dictated by the stability of the femoral implant: if the stem remains well-fixed the fracture can be treated with osteosynthesis, otherwise revision of the implant must be considered.…”
Section: Methodsmentioning
confidence: 99%
“… 22 , 39 , 80 , 101 However, there are cases in which patients are not suitable for surgery from a medical and anaesthesiologic point of view, therefore conservative treatment remains the only possible option. 8 , 9 , 35 , 36 , 66 , 69 …”
Introduction. The ever-expanding indications for total hip arthroplasty are leading to more implants being placed in younger as well as in older patients with high functional demand. Also, prolonged life expectancy is contributing to an overall increment of periprosthetic femoral fractures. The Vancouver classification has been the most used for guiding the surgeon choice since its proposal in 1995. Fractures occurring over a hip femoral implant can be divided into intra-operative and post-operative PFFs, and their treatment depends on factors that may severely affect the outcome: level of fracture, implant stability, quality of bone stock, patients’ functional demand, age and comorbidities, and surgeon expertise. There are many different treatment techniques available which include osteosynthesis and revision surgery or a combination of both. The goals of surgical treatment are patients’ early mobilization, restoration of anatomical alignment and length with a stable prosthesis and maintenance of bone stock. Significance. The aim of this review is to describe the state-of-the-art treatment and outcomes in the management of PFFs. We performed a systematic literature review of studies reporting on the management of PFFs around hip stems and inter-prosthetic fractures identifying 45 manuscripts eligible for the analysis. Conclusions. PFFs present peculiar characteristic that must be considered and special features that must be addressed. Their management is complex due to the extreme variability of stem designs, the possibility of having cemented or uncemented stems, the difficulty in identifying the “real” level of the fracture and the actual stability of the stem. As a result, the definition of a standardized treatment is unlikely, thereby high expertise is fundamental for the surgical management of PPFs, so this kind of fractures should be treated only in specialized centres with both high volume of revision joint arthroplasty and trauma surgery.
“…The treatment of PPF of the hip is currently guided by the most widely utilized Vancouver classification system [9,10]. A broad consensus exists regarding the treatment of Vancouver A and C fractures, but there is an ongoing discussion about the validity of the Vancouver B subtypes and, therefore, new classification systems were developed [10][11][12].…”
Purpose
Effective therapy of periprosthetic femur fractures of the hip (PPF) are challenging due to patients’ frailty and complexity of fracture patterns. The aim of this cohort study was to analyze the radiological and functional outcome following PPF.
Methods
A retrospective, multicenter study in the period 2009–2019 of patients with PPF at two level I trauma centers in Germany was performed. PPF were classified according to the Vancouver classification system. Demographic data, American Society of Anesthesiologists (ASA) classification, type of surgery, complications, and reoperation rate were obtained from patient records. The functional outcome was assessed by the modified Harris-Hip Score (mHHS), general health using the EQ-5D, and radiological outcome by Beals & Tower (B&T) criteria.
Results
A total of 129 patients with a mean age of 79 years (range 43–102) were included. 70% of all patients were female and 68% of the patients had an ASA score ≥ 3. 20 patients suffered from a Vancouver A, 90 from a Vancouver B and 19 from a Vancouver C fracture. 14% of the patients died within the first 2 years after surgery. The reoperation rate after open reduction and internal fixation (ORIF) (n = 60) was 8% and after revision arthroplasty (RA) (n = 47) 30% (OR 3.4, 95% CI [1.21–10.2]). Mean mHHS (n = 32) was 53 ± 19.4 and EQ-VAS was 50 ± 24.6. According to B&T criteria, 82% of patients treated with ORIF (n = 17) and 62% after RA (n = 13) showed an excellent outcome.
Conclusion
Patients with a PPF of the hip are elderly and at increased operative risk. In cases with a stable prosthesis, ORIF provides good radiological outcome with low reoperation rates. In case of RA, the risk for revision surgery is higher.
ObjectivePreoperative risk prediction models can support shared decision‐making before total hip arthroplasties (THAs). Here, we compare different machine‐learning (ML) approaches to predict the six‐month risk of adverse events following primary THA to obtain accurate yet simple‐to‐use risk prediction models.MethodsWe extracted data on primary THAs (N = 262,356) between 2010 and 2018 from the Nordic Arthroplasty Register Association dataset. We benchmarked a variety of ML algorithms in terms of the area under the receiver operating characteristic curve (AUROC) for predicting the risk of revision caused by periprosthetic joint infection (PJI), dislocation or periprosthetic fracture (PPF), and death. All models were internally validated against a randomly selected test cohort (one‐third of the data) that was not used for training the models.ResultsThe incidences of revisions because of PJI, dislocation, and PPF were 0.8%, 0.4%, and 0.3%, respectively, and the incidence of death was 1.2%. Overall, Lasso regression with stable iterative variable selection (SIVS) produced models using only four to five input variables but with AUROC comparable to more complex models using all 32 variables available. The SIVS‐based Lasso models based on age, sex, preoperative diagnosis, bearing couple, fixation, and surgical approach predicted the risk of revisions caused by PJI, dislocations, and PPF, as well as death, with AUROCs of 0.61, 0.67, 0.76, and 0.86, respectively.ConclusionOur study demonstrates that satisfactory predictive potential for adverse events following THA can be reached with parsimonious modeling strategies. The SIVS‐based Lasso models may serve as simple‐to‐use tools for clinical risk assessment in the future.
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