Periprosthetic Fracture around a Cemented Stem in Total Hip Arthroplasty

Heu, Jun-Young; Kim, Ju-Yeong; Lee, Se‐Won

doi:10.5371/hp.2022.34.3.140

Cited by 7 publications

(7 citation statements)

References 44 publications

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“…By using data from the NJR, they identified 2,158 primary THA employing this implant and found a revision risk that was nearly double that observed with the standard Exeter ® stem at 10-years follow-up [ 10 ]. Periprosthetic fracture was one of the largest contributors to the revision of the SRS stem [ 10 ], which is consistent with the increased risk associated with the collarless polished taper slip design [ 24 , 25 ]. A systematic review by Thompson et al [ 24 ] found 25 reported cases of prosthetic fractures of Exeter ® stems and demonstrated that short (125 mm) stem length was more likely to fracture, and of the seven reported short stems, four were SRS (44/00/125).…”

Section: Discussionmentioning

confidence: 70%

“…However, there were no reported SRS fractures in the current series and the survival was equal to that observed with a standard stem. There is also an associated increased risk of periprosthetic fracture with shorter stem length around a cemented polished taper stem implant, such as the Exeter ® stem [ 25 , 26 ]. Therefore the short-cemented Exeter ® stem may be subject to periprosthetic fracture, but the rate in the current series was low.…”

Section: Discussionmentioning

confidence: 99%

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Standard versus short stem cemented Exeter® when used for primary total hip arthroplasty: a survivorship analysis

Clement,

Yapp,

Baxendale-Smith

et al. 2023

Arthroplasty

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Aims The aims were to compare the survival of the cemented standard (150 mm) with the short (DDH [35.5 mm offset or less], number 1 short stem [125 mm options of 37.5 mm, 44 mm, 50 mm offset] and revision [44/00/125]) Exeter® V40 femoral stems when used for primary total hip arthroplasty (THA). Methods Patients were retrospectively identified from an arthroplasty database. A total of 664 short stem Exeter® variants were identified, of which 229 were DDH stems, 208 number 1 stems and 227 revision stems were implanted between 2011 and 2020. A control group of 698 standard Exeter® stems used for THA was set up, and were followed up for a minimum of 10 years follow-up (implanted 2011). All-cause survival was assessed for THA and for the stem only. Adjusted analysis was undertaken for age, sex and ASA grade. Results The median survival time for the short stems varied according to design: DDH had a survival time of 6.7 years, number 1 stems 4.1 years, and revision stems 7.2 years. Subjects in the short stem group (n = 664) were significantly younger (mean difference 5.1, P < 0.001) and were more likely to be female (odds ratio 1.89, 95% CI 1.50 to 2.39, P < 0.001), compared to the standard group. There were no differences in THA (P = 0.26) or stem (P = 0.35) survival at 5 years (adjusted THA: 98.3% vs. 97.2%; stem 98.7% vs. 97.8%) or 10 years (adjusted THA 97.0% vs. 96.0 %; stem 96.7% vs. 96.2%) between standard and short stem groups, respectively. At 5 years no differences were found in THA (DDH: 96.7%, number 1 97.5%, revision 97.3%, standard 98.6%) or stem (DDH: 97.6%, number 1 99.0%, revision 97.3%, standard 98.2%) survival between/among the different short stems or when compared to the standard group. Conclusion The Exeter® short stems offer equivocal survival when compared to the standard stem at 5- to 10-year follow-up, which does not seem to be influenced by the short stem design.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Standard versus short stem cemented Exeter® when used for primary total hip arthroplasty: a survivorship analysis

Clement,

Yapp,

Baxendale-Smith

et al. 2023

Arthroplasty

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“…However, no data are available in the literature on the dislocation rate in THR for PFF with a monoblock stem. Further studies will be needed to better estimate the dislocation rate in this patient cohort ( 58 ).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of modular stem for the treatment of periprosthetic femoral fracture: a systematic review of the literature

Cacciola,

Braconi,

Bosco

et al. 2023

Ann Joint

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Background Periprosthetic femoral fractures (PFFs) are a frequent complication after total hip arthroplasty (THA). Both modular and non-modular tapered fluted titanium (TFT) stems could be used in total hip revisions (THRs). Nevertheless, the most appropriate femoral stem type is still under debate. The current systematic review aims to analyze the survival rate and all causes of stem revision, the overall complication rate and reason for reoperation, and patient reported outcome measures (PROMs) in THR for PFF using the modular tapered titanium stems (MTTS). Methods A comprehensive search in four databases, PubMed, Scopus, Embase, and the Cochrane Database of Systematic Reviews databases, was performed, and following the PRISMA guidelines, a systematic review was conducted. Strict inclusion and exclusion criteria were applied, starting from 1,259 studies. The risk of bias was analyzed according to the MINORS tool system. Descriptive statistical analysis was performed for all data extracted. Results Eighteen clinical studies were included in the qualitative analysis for a total of 775 patients enrolled. A mean MINORS criteria score of 9.8 [8–12] was reported. The overall survival of MTTS for PFF treatment was 95.4%, with an overall reintervention rate of 10.3% at an average follow-up of 4.5 years. Despite the use of modular components, postoperative hip instability remains the most frequent complication and cause of reintervention in these patients. In addition, a mean postoperative Harris Hip Score (HHS) of 78.1 was reported, which was considered acceptable given the high mean age of 74.1 years at the time of the revision. Conclusions Several therapeutic approaches and a wide variety of implants have been described in the literature for PFF management; however, no one solution has proven superior to others in the PFF treatment. MTTS has become a commonly used treatment option for Vancouver B2 and B3 fractures because they provide good clinical and radiological results with a reasonable survival rate. However, the complication rate of MTTS is still high.

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“…The phenomenon of an aging population has resulted in a notable increase in THA surgeries, which in turn has led to a rise in postoperative PFFs. Research indicates that individuals who are 85 years of age or older are especially susceptible to adverse effects following a hip fracture, including diminished functional outcomes and elevated mortality rates [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…An additional crucial factor to consider is the influence of sarcopenia and osteoporosis on the elderly population, rendering them more prone to falls and less capable of withstanding impact. Consequently, this elevates the likelihood of experiencing proximal femoral fractures [7,14]. This article aims to examine the present understanding of PFFs, taking into account their growing prevalence, the developing classification systems, the influence of implant selection, and the significance of patient-specific risk factors.…”

Section: Introductionmentioning

confidence: 99%

Exploring Individualized Approaches to Managing Vancouver B Periprosthetic Femoral Fractures: Insights from a Comprehensive Case Series Analysis

Cursaru,

Popa,

Cretu

et al. 2024

Cureus

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The increasing prevalence of periprosthetic femoral fractures, specifically in the vicinity of the hip, has emerged as a significant issue in recent times. Consequently, there is a need for a thorough examination to enhance the effectiveness of management and treatment approaches. The findings of this study emphasize a significant disparity in the occurrence and characteristics of these fractures, and the multiple cases have highlighted the efficacy of various treatment strategies, such as open reduction and internal fixation, as well as the utilization of cortical strut allografts. Furthermore, the study has identified potential risk factors that have an impact on the characteristics of fractures, providing valuable insights that could be crucial in the development of preventive strategies. This study provides a thorough examination of periprosthetic femoral fractures, highlighting the importance of a cohesive treatment algorithm to improve the handling of such fractures. Moreover, it promotes the need for a collaborative endeavor in conducting research in this field, cultivating a more profound comprehension that has the potential to drive progress in therapeutic approaches, ultimately enhancing patient results over an extended period of time. It is crucial that forthcoming research endeavors persist in expanding upon these discoveries, striving towards a unified methodology in tackling this substantial clinical obstacle.

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Periprosthetic Fracture around a Cemented Stem in Total Hip Arthroplasty

Cited by 7 publications

References 44 publications

Standard versus short stem cemented Exeter® when used for primary total hip arthroplasty: a survivorship analysis

Standard versus short stem cemented Exeter® when used for primary total hip arthroplasty: a survivorship analysis

Outcomes of modular stem for the treatment of periprosthetic femoral fracture: a systematic review of the literature

Exploring Individualized Approaches to Managing Vancouver B Periprosthetic Femoral Fractures: Insights from a Comprehensive Case Series Analysis

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