Treatment of periprosthetic femoral fractures with modular stems

Hernández-Vaquero, Daniel; Fernández-Lombardía, J.; Rios, Jimena Llorens de los; Pérez-Coto, Iván; Iglesias-Fernandez, S

doi:10.1007/s00264-015-2958-5

Cited by 13 publications

(7 citation statements)

References 24 publications

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“…The excellent implant survivorship found in this study is consistent with what has previously been published 11-17,21,27-31 (Table V). Otero et al 10 reported only 1 case of aseptic femoral loosening in a series of 47 periprosthetic femoral fractures.…”

Section: Discussionsupporting

confidence: 92%

Modular Fluted Tapered Stems for Periprosthetic Femoral Fractures

Hannon

Sheehan

Duong

et al. 2022

Journal of Bone and Joint Surgery

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Background:Modular fluted tapered (MFT) stems have advanced treatment of Vancouver B2 and B3 periprosthetic femoral fractures, but series to date have been limited with respect to cohort size and follow-up duration. The purpose of this study was to determine implant survivorship, radiographic results, complications, and clinical outcomes of Vancouver B2 and B3 periprosthetic femoral fractures treated with MFT stems in a large series of patients.Methods:We identified 171 Vancouver B2 (109) and B3 (62) periprosthetic femoral fractures treated with an MFT stem between 2000 and 2018 using our institutional total joint registry. The mean age was 75 years, 50% were female, and the mean body mass index was 29 kg/m2. The median stem diameter was 18 mm and median stem length was 210 mm. The cumulative incidences of revision and reoperation with death as the competing risk were calculated, radiographs were reviewed, and clinical outcomes were evaluated using the Harris hip score (HHS). The mean follow-up was 5 years.Results:The 10-year cumulative incidence of any revision was 10%. There were 17 revisions, of which only 3 were for the distal fluted portion of the MFT stem. Revision indications included periprosthetic joint infection (PJI) (n = 6) and dislocation (n = 11). The 10-year cumulative incidence of any reoperation was 15%. In addition to the above 17 revisions, there were 7 reoperations for superficial wound complications (n = 4), Vancouver B1 periprosthetic femoral fracture (n = 1), vascular occlusion (n = 1), and acetabular cartilage degeneration requiring an acetabular component (n = 1). Radiographically, there was 1 fracture nonunion. All unrevised MFT stems were radiographically well fixed. Subsidence of ≥5 mm occurred in 11%, but all implants were stable at the most recent follow-up. The mean HHS was 75 at 2 years (n = 71).Conclusions:In this large series of 171 Vancouver B2 and B3 periprosthetic femoral fractures treated with MFT stems, we found that such constructs were associated with a high rate of fracture healing and provided extremely reliable and durable implant fixation, with no revisions for aseptic loosening. Dislocation and PJI were the most common complications.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 92%

Modular Fluted Tapered Stems for Periprosthetic Femoral Fractures

Hannon

Sheehan

Duong

et al. 2022

Journal of Bone and Joint Surgery

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“…A mean MINORS criteria score of 9.8 [8–12] was reported. Six studies were classified as “excellent” ( 21 , 22 , 24 , 29 - 31 ), while the quality of the remaining studies was classified as “moderate” ( 17 - 20 , 23 , 25 - 27 , 31 - 34 ). No studies were classified as “very bad”.…”

Section: Resultsmentioning

confidence: 99%

“…Among the 18 studies included, only 2 reported the preoperative HHS ( 18 , 19 ), while 12 mentioned only the postoperative HHS ( 20 - 22 , 25 - 27 , 29 , 30 , 31 - 34 ), and 4 did not report the HHS ( 23 , 24 , 28 , 31 ). The postoperative HHS had an average value of 78.1 [20–100].…”

Section: Resultsmentioning

confidence: 99%

“…The overall MTTS survivorship rate in THR for PFF was 95.4%. Among all included studies, six papers reported 100% overall survival; specifically, three papers considered an average follow-up between 1 and 3 years ( 17 , 21 , 24 ), two studies between 3 and 5 years of follow-up ( 25 , 28 ), and the last one included patients with more than 5 years of follow-up ( 18 ). To better evaluate overall survival over time, stem survivorship was analyzed according to follow-up period: stem survival was 97% in studies with an average follow-up of fewer than 3 years, 95.8% in papers with a mean follow-up between 3 and 5 years, and 93.6% in studies with an average follow-up longer than 5 years.…”

Section: Discussionmentioning

confidence: 99%

“…After evaluating the inclusion and exclusion criteria, eighteen clinical studies ( 17 - 34 ) were included in the final analysis ( Figure 1 ). Specifically, fifteen retrospective case series ( 17 - 20 , 22 , 23 , 25 , 27 - 34 ), two prospective case series ( 21 , 24 ), and one retrospective comparative study ( 26 ) were analyzed. Additional relevant articles were searched through analysis of the bibliography of included studies.…”

Section: Methodsmentioning

confidence: 99%

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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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