Periprosthetic Hip Fractures With a Loose Stem: Open Reduction and Internal Fixation Versus Stem Revision

González-Martín, David; País-Brito, José Luis; González-Casamayor, Sergio; Guerra-Ferraz, Ayron; Martín-Vélez, P.; Herrera-Pérez, Mario

doi:10.1016/j.arth.2021.05.003

Cited by 13 publications

(18 citation statements)

References 60 publications

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“…Baker et al recently presented an interesting article in which they analyzed the decision-making process in this particularly vulnerable group [ 15 ]. The authors conclude that the participation of geriatricians in this decision-making process is crucial when assessing the fragility of these patients, as part of the multidisciplinary team including orthopedic surgeons, anesthesiologists, nurses, and social agents, as occurs in our center [ 40 , 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Ethical Dilemmas with Regard to Elderly Patients with Hip Fracture: The Problem of Nonagenarians and Centenarians

Herrera-Pérez

González-Martín

Sanz

et al. 2022

JCM

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Hip fracture is the most feared complication of osteoporosis, producing up to 30% mortality at the first year. With the aging of society, it is increasingly common to deal with ethical dilemmas that involve decision making in the elderly patient with a hip fracture. The objectives of the present work are to describe the main bioethical dilemmas in this group of patients and their relationship with surgical delay. We conducted a retrospective descriptive study that studied an elderly population admitted to a University Hospital with a diagnosis of hip fracture. In total, 415 patients were analyzed. The majority received surgical treatment, a correct application of the principles of justice, non-maleficence and beneficence is verified, but a possible violation of the principle of autonomy is confirmed. Based on the results of this study, the elderly population may somehow lose their principle of autonomy when they enter a hospital due to a hip fracture. On the other hand, the so-called ageism due to ignorance can influence the surgical delay and therefore the mortality of these patients.

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Section: Discussionmentioning

confidence: 99%

Ethical Dilemmas with Regard to Elderly Patients with Hip Fracture: The Problem of Nonagenarians and Centenarians

Herrera-Pérez

González-Martín

Sanz

et al. 2022

JCM

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“…Several studies have been published reporting good results in VB2 PPHF treated with osteosynthesis [4,5,11] and some of their authors have argued that the Vancouver classification, although very useful, should include the patient's previous functionality, the anesthetic risk, comorbidities, the possibility of achieving anatomical reduction, the stability of the cement mantle, age, and the surgeon's experience in deciding what type of treatment to perform [5,8,9,11]. In our hospital, the decision on whether to perform osteosynthesis or stem revision is made based on the Vancouver classification, previous mobility, whether the fracture pattern [20] made anatomical reconstruction possible, anesthetic risk, comorbidities, previous hip pain, and the experience of the senior orthopedic surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…Stoffel et al [3] conducted a systematic review of osteosynthesis vs. revision arthroplasty in cases of loosened stems (V-B2/B3) and reported that, in certain cases, osteosynthesis can deliver equivalent or even better results [1,[3][4][5][6][7][8][9][10][11]21]. On the other hand, Khan et al [22] in another review on the same topic showed that osteosynthesis alone is associated with a higher percentage of reoperation rate, but the relative risk did not reach a statistically significant value [22].…”

Section: Discussionmentioning

confidence: 99%

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Is Stem Revision Necessary for Vancouver B2 Periprosthetic Hip Fractures? Analysis of Osteosynthesis Results from 39 Cases

González-Martín

González-Casamayor

Herrera-Pérez

et al. 2021

JCM

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Although stem revision is recommended for Vancouver B2 periprosthetic hip fractures (PPHFs), there has recently been a debate whether, under certain conditions, they could be treated by osteosynthesis alone. This study aimed to describe the medium-term clinical and radiological results of several patients with V-B2 fractures treated via osteosynthesis. A retrospective study of patients with V-B2 PPHF treated by osteosynthesis without stem revision, operated on between 2009 and 2019, was performed. The type of arthroplasty, type of stem, ASA, Charlson Comorbidity Index (CCI), medical and implant complications, reoperation rate, first-year mortality, radiological results (consolidation time), and functional results were analyzed. Thirty-nine patients were included. Their average age was 78.82 years. Most of the patients presented ASA ≥ 3 (35/39) and CCI ≥ 5 (32/39). Radiological consolidation was achieved in 93.5% of patients, with an average consolidation time of 92.93 days. The average Parker test score before admission was 5.84 while the current one was 4.92 (5.16 years follow-up). Osteosynthesis without stem revision is a valid surgical alternative in certain types of patients with V-B2 PPHF, depending on previous mobility, fracture pattern (anatomical reconstruction possible), anesthetic risk, comorbidities, and previous hip pain.

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“…Periprosthetic hip fracture (PPHF) is a potentially devastating complication following total hip arthroplasty (THA), with high first-year mortality (15-20%) when occurring in frail elderly patients (1,2,3).…”

Section: Introductionmentioning

confidence: 99%

Treatment algorithm in Vancouver B2 periprosthetic hip fractures: osteosynthesis vs revision arthroplasty

et al. 2022

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There is currently a debate on whether all Vancouver B2 periprosthetic hip fractures should be revised. The aim of our work was to establish a decision-making algorithm that helps to decide whether open reduction and internal fixation (ORIF) or revision arthroplasty (RA) should be performed in these patients. Relative indications in favour of ORIF are low-medium functional demand (Parker mobility score (PMS) <5), high anaesthetic risk (American Society of Anesthesiologists score (ASA) ≥ 3), many comorbidities (Charlson Comorbidity Index (CCI) ≥ 5), 1 zone fractured (VB2.1), anatomical reconstruction possible, and no prior loosening (hip pain). Relative indications in favour of RA are high functional demand (PMS ≥6), low anaesthetic risk (ASA< 3), few comorbidities (CCI<5), fracture ≥ 2 zones (VB2.2), comminuted fractures, and prior loosening (hip pain). In cemented stems, those fractures with fully intact cement–bone interface, no stem subsidence into the cementraliser, cement mantle anatomically reducible, and some partial stem-cement attachment can be safely treated with ORIF.

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Periprosthetic Hip Fractures With a Loose Stem: Open Reduction and Internal Fixation Versus Stem Revision

Cited by 13 publications

References 60 publications

Ethical Dilemmas with Regard to Elderly Patients with Hip Fracture: The Problem of Nonagenarians and Centenarians

Ethical Dilemmas with Regard to Elderly Patients with Hip Fracture: The Problem of Nonagenarians and Centenarians

Is Stem Revision Necessary for Vancouver B2 Periprosthetic Hip Fractures? Analysis of Osteosynthesis Results from 39 Cases

Treatment algorithm in Vancouver B2 periprosthetic hip fractures: osteosynthesis vs revision arthroplasty

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