High incidence of complications and poor clinical outcome in the operative treatment of periprosthetic femoral fractures: An analysis of 71 cases

Abstract

High incidence of complications and poor clinical outcome in the operative treatment of periprosthetic femoral fractures Zuurmond, R.G.; van, Wijhe W.; van Raay, J.J.; Bulstra, Sjoerd K. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Total hip arthroplasty (THA) is among the most successful operative procedures known to medicine, because of which the prevalence of this procedure is rapidly increasing. However, with the success the downside becomes increasingly important as well: the complications associated with THA. Although the number of serious complications on the long term is low, a serious complication is the periprosthetic fracture (PPF) of the femur. Often, these fractures occur in older, compromised patients, raising mortality rates. 10 The increase in the number of patients treated with THA, as well as people getting older, create a large population 'at risk'. In the literature, the increasing incidence of PPF has been reported by a number of study groups. 7,15Several retrospective studies have been published, however, with limited information on clinical outcomes. 1,11,16 Using the Swedish Arthroplasty Register, Lindahl et al. were able to report a large prospective series and identify risk factors for PPF (e.g., stem design). 8 Derived from questionnaires at follow-up, their patients showed an impaired hip function and low health status. We performed a retrospective study in two hospitals and included the Oxford hip score questionnaire and a review of the complete radiologic follow-up. According to clinical observations and literature reports, we expected high major complication rates, especially re-operations. Osteosynthesis performed for Vancouver type-B fractures were expected to have a high failure rate as previously described in literature reports. We posed the following research questions: Does the treated PPF population show a high complication rate? Do these patients show an impaired functional outcome and is this influenced by the method of treatment? Background:The purpose of this observational study was to determine the clinical results of the operative treatment of periprosthetic femoral fractures over a long period of time. Methods: The medical records of patients treated between 1993 and 2006 for a periprosthetic femoral fracture were obtained after a survey in two major hospitals. Radiographic evaluation was performed according to the Vancouver classification. All patients were contacted to fill out the Oxford hip score. Results: A total of 80 PPFs were identified in 79 patients. For 71 patients with 71 fractures, medical records and radiographs were available. The mean age at the time of fracture was 73.4 years (range: 38-95 years). The mean interv...

Outcomes following surgical treatment of periprosthetic femur fractures: a single centre series

“…9,21 Infection and nonunion were the most common complications in our series. When infections were adequately eradicated, the fractures usually went on to attain union.…”

“…In another study on periprosthetic fractures treated with ORIF, 20 of 66 patients had no great signs of fracture union 6 months postoperatively. 9 This is in sharp contrast to nonprosthetic femur fractures, which have been reported to unite by 3 months. 20 When managing patients with delayed union and minimal pain who show no signs of implant failure, the risks associated with reoperation must be weighed against those associated with close observation.…”

“…Surgical management of periprosthetic fractures can result in high complication and reoperation rates. 8,9 We performed a retrospective review of patients who sustained a periprosthetic fracture around the femur after THA. This study reports on the results of treatment and complication rates at our institution.…”

“…17,18 Despite these modern techniques, failure rates remain relatively high in most series. 9 In particular, periprosthetic fractures (B1 and C) treated with ORIF still have significant failure rates (18%-33%). 9,19 In our study, the fracture patterns that were most likely to require revision or even multiple revisions were B1 and C fractures.…”

“…9 In particular, periprosthetic fractures (B1 and C) treated with ORIF still have significant failure rates (18%-33%). 9,19 In our study, the fracture patterns that were most likely to require revision or even multiple revisions were B1 and C fractures. Failures in these patients were either due to unrecognized prosthetic loosening and/or suboptimal internal fixation.…”