Periprosthetic Femoral Fracture within Two Years After Total Hip Replacement

Thien, Truike M; Chatziagorou, Georgios; Garellick, Göran; Furnes, Ove; Havelin, Leif Ivar; Mäkelä, Keijo; Overgaard, Søren; Pedersen, Alma B; Eskelinen, Antti; Pulkkinen, Pekka; Kärrholm, Johan

doi:10.2106/jbjs.m.00643

Cited by 209 publications

(99 citation statements)

References 18 publications

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“…The second reason for increase for re‐operations/revisions is periprosthetic fractures as we have seen an increase in periprosthetic fractures treated surgically in the early post‐operative stages. This finding has also been reported by Thien et al33 and Pedersen et al,32 who described in two studies both from the Nordic Arthroplasy Register Association (NARA) database the association between fixation technique and revision risk and concluded there was an increase of early revisions with use of uncemented fixation.…”

Section: Discussionsupporting

confidence: 82%

Trends in hip replacements between 1999 and 2012 in Sweden

Cnudde

Nemes

Bülow

et al. 2017

Journal Orthopaedic Research

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National Registers document changes in the circumstance, practice, and outcome of surgery with the passage of time. In the context of total hip replacement (THR), registers can help elucidate the relevant factors that affect the clinical outcome. We evaluated the evolution of factors related to patient, surgical procedure, socio‐economy, and various outcome parameters after merging databases of the Swedish Hip Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare. Data on 193,253 THRs (164,113 patients) operated between 1999 and 2012 were merged. We studied the evolution of surgical volume, patient demographics, socio‐economic factors, surgical factors, length‐of‐stay, mortality rate, adverse events, re‐operation and revision rates, and Patient Reported Outcome Measures (PROMs). Throughout this time period the majority of patients were operated on with a diagnosis of primary osteoarthritis. Comorbidity indices increased each year observed. The share of all‐cemented implants has dropped from 92% to 68%. More than 88% of the bearings were metal‐on‐polyethylene. Length‐of‐stay decreased by 50%. There was a reduction in 30‐ and 90‐day mortality. Re‐operation and revision rates at 2 years are decreasing. The post‐operative PROMs improved despite the observation of worse pre‐operative pain scores getting over time. The demographics of patients receiving a THR, their comorbidities, and their primary diagnosis are changing. Notwithstanding these changes, outcomes like mortality, re‐operations, revisions, and PROMs have improved. The practice of hip arthroplasty has evolved, even in a country such as Sweden that is considered to be conservative with regard taking on new surgical practices. © 2017 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:432–442, 2018.

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Section: Discussionsupporting

confidence: 82%

Trends in hip replacements between 1999 and 2012 in Sweden

Cnudde

Nemes

Bülow

et al. 2017

Journal Orthopaedic Research

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“…However, the revision risk of the Exeter stem regarding periprosthetic fracture is higher than for the Lubinus SP II stem (Thien et al. 2014). …”

Section: Discussionmentioning

confidence: 99%

Implant survival of the most common cemented total hip devices from the Nordic Arthroplasty Register Association database

Junnila¹,

Laaksonen²,

Eskelinen³

et al. 2016

Acta Orthopaedica

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Background and purposeAccording to previous Nordic Arthroplasty Register Association (NARA) data, the 10-year implant survival of cemented total hip arthroplasties (THAs) is 94% in patients aged 65–74 and 96% in patients aged 75 or more. Here we report a brand-level comparison of cemented THA based on the NARA database, which has not been done previously.Patients and methodsWe determined the rate of implant survival of the 9 most common cemented THAs in the NARA database. We used Kaplan-Meier analysis with 95% CI to study implant survival at 10 and 15 years, and Cox multiple regression to assess survival and hazard ratios (HRs), with revision for any reason as endpoint and with adjustment for age, sex, diagnosis, and femoral head material.ResultsSpectron EF THA (89.9% (CI: 89.3–90.5)) and Elite THA (89.8% (CI: 89.0–90.6)) had the lowest 10-year survivorship. Lubinus (95.7% survival, CI: 95.5–95.9), MS 30 (96.6%, CI: 95.8–97.4), and C-stem THA (95.8%, CI: 94.8–96.8) had a 10-year survivorship of at least 95%. Lubinus (revision risk (RR) = 0.77, CI: 0.73–0.81), Müller (RR =0.83, CI: 0.70–0.99), MS-30 (RR =0.73, CI: 0.63–0.86), C-stem (RR =0.70, CI: 0.55–0.90), and Exeter Duration THA (RR =0.84, CI: 0.77–0.90) had a lower risk of revision than Charnley THA, the reference implant.InterpretationThe Spectron EF THA and the Elite THA had a lower implant survival than the Charnley, Exeter, and Lubinus THAs. Implant survival of the Müller, MS 30, CPT, and C-stem THAs was above the acceptable limit for 10-year survival.

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“…[1] With the surgical indications broadened and the improvement of prosthetic materials for THA, [2–4] the number of patients receiving THA is steadily increasing. [5–7] Accordingly, the number of complications related to THA also has increased, including periprosthetic femoral fracture (PFF).…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty

et al. 2016

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Periprosthetic femoral fracture (PFF) is a complicated complication of both primary and revision hip arthroplasty with an increasing incidence. The present study aimed to summarize the clinical characteristics and identify the risk factors for PFF which would be potentially helpful in the prevention and treatment of PFF.We retrospectively analyzed the clinical data of 89 cases of PFF, and a case–control study was designed to identify the potential risk for intraoperative and postoperative PFF in both primary and revision hip arthroplasty.The overall incidence of PFF was 2.08% (intraoperative: 1.77%, postoperative: 0.30%, revision: 13.60%, and primary: 0.97%). The most commonly used treatment strategy was fixation with cerclage wire or band for intraoperative PFF, whereas long stem revision with plate or cortical allograft strut fixation was the main treatment strategy for postoperative PFF. The risk factors for intraoperative PFF in primary total hip arthroplasty (THA) included the diagnosis of development dysplasia of the hip (DDH) (odds ratio [OR] = 5.01, 95%CI, 1.218–20.563, P=0.03) and CBR ≥ 0.49 (OR = 3.34, 95%CI, 1.138–9.784, P = 0.03). The increased age was associated with increased incidence of postoperative PFF in primary THA (OR = 1.09, 95%CI, 1.001–1.194, P = 0.04). As for the intraoperative PFF in revision THA, we found that receiving multiple operations before revision (OR = 2.45, 95%CI, 1.06–5.66, P = 0.04), revisions due to prosthetic joint infection (OR = 6.72, 95%CI, 1.007–44.832, P = 0.04), the presence of cementless implant before revision (OR = 13.54, 95%CI, 3.103–59.08, P = 0.001), and femoral deformity (OR = 8.03, 95%CI, 1.656–38.966, P = 0.01) were all risk factors.Screening for high-risk patients, preoperative templating, and detailed discharge instructions may be the potential strategies to reduce the incidence of PFF. The treatment of PFFs should take into account Vancouver classification system, patient's characteristics as well as the experience of the operating surgeon.

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Periprosthetic Femoral Fracture within Two Years After Total Hip Replacement

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 209 publications

References 18 publications

Trends in hip replacements between 1999 and 2012 in Sweden

Trends in hip replacements between 1999 and 2012 in Sweden

Implant survival of the most common cemented total hip devices from the Nordic Arthroplasty Register Association database

Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty

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