Periprosthetic femoral fractures and trying to avoid them

Carli, Alberto; Negus, Jonathan; Haddad, Fares S.

doi:10.1302/0301-620x.99b1.bjj-2016-0220.r1

Cited by 158 publications

(57 citation statements)

References 69 publications

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“…We chose to study only young and middle‐aged patients without osteoporosis, in whom uncemented THA is the method of choice . The increased risk for periprosthetic fractures for uncemented femoral implants in elderly females and osteoporotic patients is one argument to restrict uncemented implants to the younger subset of patients suitable for THA . From a Swedish perspective, uncemented THA in the elderly is an uncommon procedure .…”

Section: Discussionmentioning

confidence: 99%

“…(4) The increased risk for periprosthetic fractures for uncemented femoral implants in elderly females and osteoporotic patients is one argument to restrict uncemented implants to the younger subset of patients suitable for THA. (29) From a Swedish perspective, uncemented THA in the elderly is an uncommon procedure. (4) In addition, previous reports and RCTs on periprosthetic BMD have often been based on younger and middle-aged patients without osteoporosis and for uncemented THA.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Denosumab Prevents Early Periprosthetic Bone Loss After Uncemented Total Hip Arthroplasty: Results from a Randomized Placebo-Controlled Clinical Trial

Nyström

Kiritopoulos

Ullmark

et al. 2019

Journal of Bone and Mineral Research

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Implant loosening is the most common indication for revision surgery after total hip arthroplasty (THA). Although bone resorption around the implants plays a pivotal role in the pathophysiology of loosening, it is unknown whether potent early inhibition of osteoclasts could mitigate this process and thus reduce the need for revision surgery. We performed a randomized, double-blind, placebo-controlled phase 2 trial in 64 patients aged 35 to 65 years with unilateral osteoarthritis of the hip. They underwent surgery with an uncemented THA and were randomized to either two subcutaneous doses of denosumab (n = 32) or placebo (n = 32) given 1 to 3 days and 6 months after surgery. Patients were followed for 24 months. Primary outcome was periprosthetic bone mineral density (BMD) of the hip at 12 months as measured by dual-energy X-ray absorptiometry (DXA). In addition, [ 18 F] sodium fluoride positron emission tomography/CT (F-PET) was performed in half of the patients for analysis of periprosthetic standardized uptake value (SUV). Analyses were made according to intention-to-treat principles. The trial was registered at ClinicalTrials.gov 2011-001481-18, NCT01630941. Denosumab potently inhibited early periprosthetic bone loss. After 12 months, BMD in the denosumab group was 32% (95% confidence interval [CI] 22-44) higher in Gruen zone 7 and 11% (95% CI 8-15) higher in zones 1 to 7. After 24 months, the difference in BMD between groups had decreased to 15% (95% CI 4-27) in zone 7 and 4% (95% CI 0-8) in zones 1 to 7. In both groups, SUV increased after surgery, but the increase was less pronounced in the denosumab group. Biochemical markers of bone metabolism decreased in the denosumab group in the first 12 months, but a rebound effect with marker concentrations above baseline was observed after 24 months. Denosumab potently prevents early periprosthetic bone loss after uncemented THA; however, the effect diminishes after discontinuation of treatment. Further research is needed to determine whether this bone loss will prove to be of clinical importance and, if so, whether the positive effect observed in this study could be preserved by either prolonged treatment with denosumab or additional antiresorptive treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Denosumab Prevents Early Periprosthetic Bone Loss After Uncemented Total Hip Arthroplasty: Results from a Randomized Placebo-Controlled Clinical Trial

Nyström

Kiritopoulos

Ullmark

et al. 2019

Journal of Bone and Mineral Research

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“…With cementless implants, there are subdivisions by shape of the femoral component. A systematic review by Carli et al showed that two subtypes of implant (single-and doublewedge) have increased rates of PFF, suggesting the geometry of the implant is a factor, in addition to the method of insertion [38]. Regarding cemented implants, polished tapered stems, which are designed to wedge in a cement mantle in the proximal femur, were associated with a greater incidence of PFF than others.…”

Section: Surgery-related Risk Factorsmentioning

confidence: 99%

Periprosthetic femoral fractures following total hip and total knee arthroplasty

et al. 2018

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Total joint arthroplasties are increasing worldwide in both frequency and prevalence. When successful, they offer great improvements in quality of life. However, fractures around implants are often difficult to manage and require prolonged inpatient stays in tertiary hospitals. Management may differ between surgeons, but most patients will be managed surgically if mobility or joint stability is threatened. Those affected are often at higher risk from surgery, are frailer and at higher risk of mortality and a lifelong reduction in mobility. The incidence of these fractures is increasing, and patients should appreciate the risk and implications of this recognised complication of joint arthroplasty. Abbreviations: THA Total hip arthroplasty TKA Total knee arthroplasty PFF Periprosthetic femoral fracture BMI Body mass index ORIF Open reduction internal fixation

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“…This was probably related to the trapezoidal shape of the implant, which sometimes may not be suitable for all proximal femoral morphologies. In this scenario, more anatomic, rounded stems may be useful to prevent PPFs when compared to single-or double-wedge components [19]. Abdel et al [20] reported a 7.7% and 3.5% risk for postoperative PFF after cementless and cemented THA, respectively, at 20 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Outcomes of the Cementless UNITED Hip System for primary Total Hip Arthroplasty at a Minimum Two-year Follow-up

Dilernia

García-Mansilla

Albani-Forneris

et al. 2020

Preprint

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Introduction: This study aimed to report the initial results of the cementless UNITED hip system in primary total hip arthroplasty (THA) with a minimum follow-up of 2 years. Methods We retrospectively studied a consecutive series of 203 cementless THAs in 180 patients operated between 2015–2017. We included 89 female and 91 male patients with a mean age of 67 (28 to 89) years. The mean follow-up was 40 (29 to 62) months. Clinical outcome scores and radiographs were measured. Survival was calculated defining failure as the need for any further femoral or acetabular revision, irrespective of the reason. Results No femoral component loosening was detected. One patient had a Vancouver-B1 intraoperative periprosthetic femoral fracture treated with implant retention and cerclage wires. Two acetabular components were revised for aseptic loosening. Three patients suffered an acute infection treated with debridement, antibiotics, and implant retention. The mean Merle d'Aubigné et Postel scores improved from 13 (4 to 16) points preoperatively to 17 (12 to 18) points at the latest follow-up (p < 0.001). At a mean time of 40 months of follow-up, the survival was 99% and 100% for the acetabular and the femoral components, respectively. Conclusion This cementless design showed excellent preliminary outcomes in terms of fixation and patient satisfaction, comparable to that of other well-known similar systems.

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Periprosthetic femoral fractures and trying to avoid them

Cited by 158 publications

References 69 publications

Denosumab Prevents Early Periprosthetic Bone Loss After Uncemented Total Hip Arthroplasty: Results from a Randomized Placebo-Controlled Clinical Trial

Denosumab Prevents Early Periprosthetic Bone Loss After Uncemented Total Hip Arthroplasty: Results from a Randomized Placebo-Controlled Clinical Trial

Periprosthetic femoral fractures following total hip and total knee arthroplasty

Preliminary Outcomes of the Cementless UNITED Hip System for primary Total Hip Arthroplasty at a Minimum Two-year Follow-up

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