Three Hundred and Twenty-one Periprosthetic Femoral Fractures

Lindahl, Hans; Garellick, Göran; Regnér, Hans; Herberts, Peter; Malchau, Henrik

doi:10.2106/jbjs.e.00457

Cited by 275 publications

(177 citation statements)

References 27 publications

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“…Thus our estimates capture the longer-term risk of living with a hip implant, as distinct from the perioperative risk of undergoing hip replacement surgery. Our work complements prior studies that have examined periprosthetic fractures in the Swedish [8,9] and Finnish [4] Hip Registers and large single center registries [7,14]. It is difficult to compare risks of fracture across these studies because of differences in patient age and the timing of the follow-up window in relation to the primary THR.…”

Section: Discussionmentioning

confidence: 90%

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Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study

Katz

Wright

Polaris

et al. 2014

BMC Musculoskelet Disord

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BackgroundThe growing utilization of total joint replacement will increase the frequency of its complications, including periprosthetic fracture. The prevalence and risk factors of periprosthetic fracture require further study, particularly over the course of long-term follow-up. The objective of this study was to estimate the prevalence and risk factors for periprosthetic fractures occurring in recipients of total hip replacement.MethodsWe identified Medicare beneficiaries who had elective primary total hip replacement (THR) for non-fracture diagnoses between July 1995 and June 1996. We followed them using Medicare Part A claims data through 2008. We used ICD-9 codes to identify periprosthetic femoral fractures occurring from 2006–2008. We used the incidence density method to calculate the annual incidence of these fractures and Cox proportional hazards models to identify risk factors for periprosthetic fracture. We also calculated the risk of hospitalization over the subsequent year.ResultsOf 58,521 Medicare beneficiaries who had elective primary THR between July 1995 and June 1996, 32,463 (55%) survived until January 2006. Of these, 215 (0.7%) developed a periprosthetic femoral fracture between 2006 and 2008. The annual incidence of periprosthetic fracture among these individuals was 26 per 10,000 person-years. In the Cox model, a greater risk of periprosthetic fracture was associated with having had a total knee replacement (HR 1.82, 95% CI 1.30, 2.55) or a revision total hip replacement (HR1.40, 95% CI 0.95, 2.07) between the primary THR and 2006. Compared to those without fractures, THR recipients who sustained periprosthetic femoral fracture had three-fold higher risk of hospitalization in the subsequent year (89% vs. 27%, p < 0.0001).ConclusionA decade after primary THR, periprosthetic fractures occur annually in 26 per 10,000 persons and are especially frequent in those with prior total knee or revision total hip replacements.

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Section: Discussionmentioning

confidence: 90%

“…Few studies have examined the prevalence of these fractures over longer-term follow-up, and there is relatively little information on risk factors for periprosthetic fracture. Limited evidence suggests an increase in risk due to older age [2], peptic ulcer [7], cardiovascular disease [7], and a loose implant [8,9]. …”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study

Katz

Wright

Polaris

et al. 2014

BMC Musculoskelet Disord

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“…Several studies have examined the cumulative incidence and risk factors for periprosthetic fractures in large samples of patients with primary THR [7–10]. Few studies have provided estimates of periprosthetic fractures in patients with revision THR [10–13] and most had small sample sizes.…”

Section: Introductionmentioning

confidence: 99%

Patient Factors Predict Periprosthetic Fractures After Revision Total Hip Arthroplasty

Singh

Jensen

Lewallen

2012

The Journal of Arthroplasty

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We assessed important patient risk factors for postoperative periprosthetic fractures after revision total hip replacement (THR) using prospectively collected Institutional Joint Registry data. We used univariate and multivariable-adjusted Cox regression analyses. There were 330 postoperative periprosthetic fractures after 6,281 revision THRs. In multivariable-adjusted analyses, hazard [95% confidence interval] of periprosthetic fracture was higher for: women, 1.66 [1.32, 2.08], p<0.001; higher Deyo-Charlson comorbidity index of 2, 1.46 (1.03, 2.07) and index of 3+, 2.01 (1.48, 2.73), overall p<0.001; and operative diagnosis, especially previous non-union, 5.76 (2.55, 13.02), overall p<0.001. Hazard was lower in 61–70 year old, 0.64 (0.49, 0.84) and 71–80 year old 0.57 (0.43, 0.76), compared to <60 years (overall p<0.0001). Our study identified important modifiable and unmodifiable risk factors for fractures after revision THR.

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“…Trauma surgeons are familiar with the management of fractures, but have less experience in managing hip arthroplasty compared with hip joint surgeons. Misinterpretation of the stem stability leading to an inappropriate selection of surgical methods26) can occur with trauma surgeons. In our case series, the preoperative assessment was carried out by both, a trauma surgeon and a hip joint surgeon, and the treatment method was selected after consultation.…”

Section: Discussionmentioning

confidence: 99%

Treatment Results of a Periprosthetic Femoral Fracture Case Series: Treatment Method for Vancouver Type B2 Fractures Can Be Customized

et al. 2014

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BackgroundCurrently, an algorithmic approach for deciding treatment options according to the Vancouver classification is widely used for treatment of periprosthetic femoral fractures after hip arthroplasty. However, this treatment algorithm based on the Vancouver classification lacks consideration of patient physiology and surgeon's experience (judgment), which are also important for deciding treatment options. The purpose of this study was to assess the treatment results and discuss the treatment options using a case series.MethodsEighteen consecutive cases with periprosthetic femoral fractures after total hip arthroplasty and hemiarthroplasty were retrospectively reviewed. A locking compression plate system was used for osteosynthesis during the study period. The fracture type was determined by the Vancouver classification. The treatment algorithm based on the Vancouver classification was generally applied, but was modified in some cases according to the surgeon's judgment. The reasons for modification of the treatment algorithm were investigated. Mobility status, ambulatory status, and social status were assessed before the fracture and at the latest follow-up. Radiological results including bony union and stem stability were also evaluated.ResultsThirteen cases were treated by osteosynthesis, two by revision arthroplasty and three by conservative treatment. Four cases of type B2 fractures with a loose stem, in which revision arthroplasty is recommended according to the Vancouver classification, were treated by other options. Of these, three were treated by osteosynthesis and one was treated conservatively. The reasons why the three cases were treated by osteosynthesis were technical difficulty associated with performance of revision arthroplasty owing to severe central migration of an Austin-Moore implant in one case and subsequent severe hip contracture and low activity in two cases. The reasons for the conservative treatment in the remaining case were low activity, low-grade pain, previous wiring around the fracture and light weight. All patients obtained primary bony union and almost fully regained their prior activities.ConclusionsWe suggest reaching a decision regarding treatment methods of periprosthetic femoral fractures by following the algorithmic approach of the Vancouver classification in addition to the assessment of each patient's hip joint pathology, physical status and activity, especially for type B2 fractures. The customized treatments demonstrated favorable overall results.

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Three Hundred and Twenty-one Periprosthetic Femoral Fractures

Cited by 275 publications

References 27 publications

Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study

Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study

Patient Factors Predict Periprosthetic Fractures After Revision Total Hip Arthroplasty

Treatment Results of a Periprosthetic Femoral Fracture Case Series: Treatment Method for Vancouver Type B2 Fractures Can Be Customized

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