One year after proximal or distal periprosthetic fracture of the femur -two conditions with divergent outcomes?

Eschbach, Daphne; Buecking, Benjamin; Kivioja, H.; Fischer, Michael J.; Wiesmann, Thomas; Zettl, Ralph; Oberkircher, Ludwig; Barthel, Juliane; Aigner, René; Ruchholtz, Steffen; Bliemel, Christopher

doi:10.1016/j.injury.2018.04.025

Cited by 26 publications

(20 citation statements)

References 29 publications

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“…Several treatment methods have been published on the surgical treatment of PFFs; most of the studies have been based on Vancouver classification (14)(15)(16)(17)(18)(19). Complications after PFFs often require re-revision surgery, like re-fractures and infections, can lead to severe disability (20,21). Moreover, PFFs are associated with high rates of mortality, particularly within the first postoperative year (8,22).…”

Section: Introductionmentioning

confidence: 99%

Retrospective Population-Based Cohort Study of Incidence, Complications, and Survival of 202 Operatively Treated Periprosthetic Femoral Fractures

Miettinen

Törmä

Lappalainen

et al. 2021

The Journal of Arthroplasty

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Introductionmentioning

confidence: 99%

Retrospective Population-Based Cohort Study of Incidence, Complications, and Survival of 202 Operatively Treated Periprosthetic Femoral Fractures

Miettinen

Törmä

Lappalainen

et al. 2021

The Journal of Arthroplasty

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“…Techniques such as propensity matching for known confounders would help mitigate the potential bias from patient selection; particularly as a number of other factors potentially influential in periprosthetic fracture outcomes have been previously described [11,17,21]. The use of large-scale registry data should also allow for the separation of periprosthetic knee and periprosthetic hip fracture patients into individual cohorts, as a previous report has suggested the possibility of difference in demographics and outcome between the two cohorts [9]. Using the results from our analysis, we have calculated an estimated sample size for such a study examining dichotomised time to surgery and 30 day mortality would require 1170 participants to appropriately investigate this primary outcome (https ://www.clinc alc.com/stats /sampl esize .aspx).…”

Section: Discussionmentioning

confidence: 99%

Does early surgery improve outcomes for periprosthetic fractures of the hip and knee? A systematic review and meta-analysis

Farrow

Ablett

Sargeant

et al. 2021

Arch Orthop Trauma Surg

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Introduction Previous evidence has established that early surgery is beneficial to improve outcomes for individuals with native hip fractures in the elderly population. Patients who sustain a periprosthetic fracture have been demonstrated to have similar demographics and outcomes as those with native fractures around the hip and knee. We therefore set out to determine if there is a similar difference in perioperative outcomes between early and delayed surgery for periprosthetic fractures of the hip and knee through a systematic review and meta-analysis. Methods Literature search outputs were screened for studies meeting the inclusion criteria. The groups of early surgery and delayed surgery were defined by study authors. The primary outcome measure was 30 day mortality. Where there was sufficient study homogeneity, a random-effects meta-analysis was performed. Individual study risk of bias was assessed using the ROBINS-I criteria, with the GRADE criteria used for independent outcome evaluation. The review protocol was registered on PROSPERO prior to commencement (Registration number CRD42019149360). Results The inclusion criteria was met in 11 studies (n = 3006). Mean time to surgery from admission for reporting studies was 64 h. 59.6% patients underwent early surgery as defined by the study authors. We identified a significantly lower risk of 30 day mortality for those with early surgery versus delayed surgery (RR 0.21; 95% CI 0.05, 0.90; p = 0.04, n = 2022). There were also significantly better outcomes for early versus delayed surgery regarding: medical complications, length of stay, transfusion risk, and reoperation. The quality of evidence for all the individual outcomes was low or very low. Conclusions There is evidence that delaying surgery in those with periprosthetic fractures of the hip and knee has a deleterious impact on mortality and other important patient outcomes. There are, however, notable limitations to the existing available literature, with further appropriately designed large-scale studies required to confirm these findings.

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“…2,15 While we did not observe difference inpatient ages between fracture types, Eschbach et al found that in their single institution's cohort of PPFX, those with knee PPFX were significantly younger and had fewer nonoperative complications than hip PPFXs. 4 There are many factors that go into surgical decisionmaking to treat PPFX with either ORIF or revision arthroplasty. In our study, we found that knee PPFXs treated with ORIF were younger and had fewer comorbidities than those treated with revision arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

“… 2 , 15 While we did not observe difference inpatient ages between fracture types, Eschbach et al found that in their single institution’s cohort of PPFX, those with knee PPFX were significantly younger and had fewer nonoperative complications than hip PPFXs. 4 …”

Section: Discussionmentioning

confidence: 99%

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Demographics, Treatment, and Cost of Periprosthetic Femur Fractures: Fixation Versus Revision

Ragland

Reif

Karim

et al. 2020

Geriatr Orthop Surg Rehabil

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Introduction: Periprosthetic femur fractures (PPFX) are complications of both total hip and knee arthroplasty and may be treated with open reduction and internal fixation (ORIF) or revision arthroplasty. Differences in treatment and fracture location may be related to patient demographics and lead to differences in cost. Our study examined the effects of demographics and treatment of knee and hip PPFXs on length of stay (LOS) and cost. Methods: Of all, 932 patients were identified with hip or knee PPFXs in the National Inpatient Sample from January 2013 to September 2015. Age, gender, race, mortality, comorbidity level, LOS, total cost, procedure type, geographic region, and hospital type were recorded. A generalized linear regression model was conducted to analyze the effect of fracture type on LOS and cost. Results: Differences in gender (66% vs 83.7% female, P < .01), comorbidities (fewer in hips, P < .01), and costs (US$30 979 vs US$27 944, P < .01) were found between the hip and knee groups. Knees had significantly higher rates of ORIF treatment (80.7% vs 39.1%) and lower rates of revision arthroplasties (19.3% vs 60.9%) than hip PPFXs ( P < .01). Within both groups, patients with more comorbidities, revision surgery, and blood transfusions were more likely to have a longer LOS and higher cost. Conclusion: Periprosthetic femur fractures patients are not homogenous and treatment varies between hip and knee locations. For knee patients, those treated with ORIF were younger, with fewer comorbidities than those treated with revision. Conversely, hip patients treated with ORIF were older, with more comorbidities than those treated with revision. Hips had higher costs than knees, and cost correlated with revision arthroplasty and more comorbidities. In both hip and knee groups, longer LOS was associated with more comorbidities and being treated in urban teaching hospitals. Total cost had the strongest associations with revision procedures as well as number of comorbidities and blood product use.

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One year after proximal or distal periprosthetic fracture of the femur -two conditions with divergent outcomes?

Cited by 26 publications

References 29 publications

Retrospective Population-Based Cohort Study of Incidence, Complications, and Survival of 202 Operatively Treated Periprosthetic Femoral Fractures

Retrospective Population-Based Cohort Study of Incidence, Complications, and Survival of 202 Operatively Treated Periprosthetic Femoral Fractures

Does early surgery improve outcomes for periprosthetic fractures of the hip and knee? A systematic review and meta-analysis

Demographics, Treatment, and Cost of Periprosthetic Femur Fractures: Fixation Versus Revision

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