Postoperative periprosthetic femoral fracture around total hip replacements: current concepts and clinical outcomes

A, Ramavath; Lamb, Jonathan; Palan, Jeya; Pandit, Hemant; Jain, Sameer

doi:10.1302/2058-5241.5.200003

Cited by 29 publications

(25 citation statements)

References 84 publications

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“…Due to an aging population in Western industrial countries, the number of performed primary and revision hip and knee arthroplasties is on the rise. Consequently, a tremendous increase in periprosthetic femoral fractures (PFFs) around the hip and knee must be expected in the future [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

Bliemel

Rascher²,

Knauf

et al. 2021

Medicina

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Background and Objectives: Appropriate timing of surgery for periprosthetic femoral fractures (PFFs) in geriatric patients remains unclear. Data from a large international geriatric trauma register were analyzed to examine the outcome of patients with PFF with respect to the timing of surgical stabilization. Materials and Methods: The Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) was analyzed. Patients treated surgically for PFF were included in this analysis. As outcome parameters, in-house mortality rate and mortality at the 120-day follow-up as well as mobility, the EQ5D index score and reoperation rate were analyzed in relation to early (<48 h) or delayed (≥48 h) surgical stabilization. Results: A total of 1178 datasets met the inclusion criteria; 665 fractures were treated with osteosynthesis (56.4%), and 513 fractures were treated by implant change (43.5%). In contrast to the osteosynthesis group, the group with implant changes underwent delayed surgical treatment more often. Multivariate logistic regression analysis of mortality rate (p = 0.310), walking ability (p = 0.239) and EQ5D index after seven days (p = 0.812) revealed no significant differences between early (<48 h) and delayed (≥48 h) surgical stabilization. These items remained insignificant at the follow-up as well. However, the odds of requiring a reoperation within 120 days were significantly higher for delayed surgical treatment (OR: 1.86; p = 0.003). Conclusions: Early surgical treatment did not lead to decreased mortality rates in the acute phase or in the midterm. Except for the rate of reoperation, all other outcome parameters remained unaffected. Nevertheless, for most patients, early surgical treatment should be the goal, so as to achieve early mobilization and avoid secondary nonsurgical complications. If early stabilization is not possible, it can be assumed that orthogeriatric co-management will help protect these patients from further harm.

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Section: Introductionmentioning

confidence: 99%

Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

Bliemel

Rascher²,

Knauf

et al. 2021

Medicina

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“…Patients will seek medical intervention acutely, therefore appearing automatically in our UR group if they attend via the emergency department (ED), whether or not they are under routine review. 8 The higher incidence of infection in knee revision cases in the UR may also be explained by the rapid onset of systemic symptoms in knee infection patients. 9 These patients often present through ED, with early progression to surgery.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of patients presenting for planned and unplanned revision hip or knee arthroplasty

Kingsbury

Smith

Shuweihdi

et al. 2022

The Bone & Joint Journal

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Aims The aim of this study was to conduct a cross-sectional, observational cohort study of patients presenting for revision of a total hip, or total or unicompartmental knee arthroplasty, to understand current routes to revision surgery and explore differences in symptoms, healthcare use, reason for revision, and the revision surgery (surgical time, components, length of stay) between patients having regular follow-up and those without. Methods Data were collected from participants and medical records for the 12 months prior to revision. Patients with previous revision, metal-on-metal articulations, or hip hemiarthroplasty were excluded. Participants were retrospectively classified as ‘Planned’ or ‘Unplanned’ revision. Multilevel regression and propensity score matching were used to compare the two groups. Results Data were analyzed from 568 patients, recruited in 38 UK secondary care sites between October 2017 and October 2018 (43.5% male; mean (SD) age 71.86 years (9.93); 305 hips, 263 knees). No significant inclusion differences were identified between the two groups. For hip revision, time to revision > ten years (odds ratio (OR) 3.804, 95% confidence interval (CI) (1.353 to 10.694), p = 0.011), periprosthetic fracture (OR 20.309, 95% CI (4.574 to 90.179), p < 0.001), and dislocation (OR 12.953, 95% CI (4.014 to 41.794), p < 0.001), were associated with unplanned revision. For knee, there were no associations with route to revision. Revision after ten years was more likely for those who were younger at primary surgery, regardless of route to revision. No significant differences in cost outcomes, length of surgery time, and access to a health professional in the year prior to revision were found between the two groups. When periprosthetic fractures, dislocations, and infections were excluded, healthcare use was significantly higher in the unplanned revision group. Conclusion Differences between characteristics for patients presenting for planned and unplanned revision are minimal. Although there was greater healthcare use in those having unplanned revision, it appears unlikely that routine orthopaedic review would have detected many of these issues. It may be safe to disinvest in standard follow-up provided there is rapid access to orthopaedic review. Cite this article: Bone Joint J 2022;104-B(1):59–67.

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“…Nowadays, surgery is more frequently carried out in older patients with poor bone quality, due to the aging of the general population and to the enlargement of surgical indications, which is related to innovative prosthetic materials and improvement in surgical technique 1 . In parallel with the rising numbers of total hip arthroplasty (THA), an increase in the number of complications, such as periprosthetic femoral fracture (PFF) are also observed 2 . PFF are defined as fractures around orthopaedics hardware like plates, nails or joint replacement 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Treatment of PFF is multifaceted and requires expertise in both fracture fixation and revision arthroplasty. Many patients are elderly with significant comorbidities and surgery is associated with high complication rates 2 . Moreover, patients affected by PFF have a relatively poor outcome with higher mortality and morbidity compared to patients undergoing prosthesis revision for aseptic loosening 3 .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Vancouver B2-type and B3-type proximal femur periprosthetic fractures after revision surgery using cementless tapered modular stem: a retrospective case series of 39 fractures

et al. 2021

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Postoperative periprosthetic femoral fracture around total hip replacements: current concepts and clinical outcomes

Cited by 29 publications

References 84 publications

Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

A comparative study of patients presenting for planned and unplanned revision hip or knee arthroplasty

Outcomes of Vancouver B2-type and B3-type proximal femur periprosthetic fractures after revision surgery using cementless tapered modular stem: a retrospective case series of 39 fractures

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