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Total hip arthroplasty ; Periprosthetic femoral fractures ; Comorbidities ; Advanced age ; Clinial Outcome ; Radiological outcome.
Purpose: The aim of the present study was to review the outcome of the surgical treatment of 54 periprosthetic femoral fractures (PFF) after total hip arthroplasty at a mean follow-up of 45 months. At final follow-up, the clinical outcome was measured using the Harris Hip score (HHS), the Karnofsky score (KS), while, the radiographic results were evaluated using the Beals and Tower’s criteria.
Results: There were 13 post-operative complications that occurred in 10 patients with an overall re-operation rate of 11%. At final follow-up the mean HHS was 64 (range 20-100) and the mean KS was 66 (range 30-100). The radiological results were excellent in 89%, good in 9% and poor 2% of patients. The mortality rate was 0% at 3 months and 3.7% at one year post-operatively.
The mean last HHS and KS of patients older than 75 years or with comorbidities were lower than that of patients younger than 75 years or without comorbidities.
Conclusions: Although this study have shown that the surgical treatment of PFF was associated with a low re-operative rate, a good to excellent radiological results and a low mortality rate at 3 months and 1 year postoperatively, there was a marked functional deterioration in many patients. This decline of function could be attributed to the advanced age of patients and the presence of comorbidities.
2- Drew JM, Griffin WL, Odum SM, Van Doren B, Weston BT, Stryker LS. Survivorship After Periprosthetic Femur Fracture: Factors Affecting Outcome. J Arthroplasty. 2016 Jun;31(6):1283-8.
3- Katz JN, Wright EA, Polaris JJ, Harris MB, Losina E. Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study. BMC Musculoskelet Disord. 2014 May 22;15:168.
4- Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty. 2005 Oct;20(7):857-65.
5- Kim YH, Mansukhani SA, Kim JS, Park JW. Use of Locking Plate and Strut Onlay Allografts for Periprosthetic Fracture Around Well-Fixed Femoral Components. J Arthroplasty. 2017 Jan;32(1):166-170
6- Joestl J, Hofbauer M2, Lang N, Tiefenboeck T, Hajdu S. Locking compression plate versus revision-prosthesis for Vancouver type B2 periprosthetic femoral fractures after total hip arthroplasty. Injury. 2016 Apr;47(4):939-43.
7- Moreta J, Aguirre U, de Ugarte OS, Jáuregui I, Mozos JL. Functional and radiological outcome of periprosthetic femoral fractures after hip arthroplasty. Injury. 2015 Feb;46(2):292-8.
8- Johnson-Lynn S, Ngu A, Holland J, Carluke I, Fearon P. The effect of delay to surgery on morbidity, mortality and length of stay following periprosthetic fracture around the hip. Injury. 2016 Mar;47(3):725-7.
9- Phillips JR, Boulton C, Morac CG, Manktelov AR. What is the financial cost of treating periprosthetic hip fractures?. Injury. 2011 Feb;42(2):146-9.
10- Harris B, Owen JR, Wayne JS, Jiranek WA. Does femoral component loosening predispose to femoral fracture?: an in vitro comparison of cemented hips. Clin Orthop Relat Res. 2010 Feb;468(2):497-503.
11- Lunebourg A, Mouhsine E, Cherix S, Ollivier M, Chevalley F, Wettstein M. Treatment of type B periprosthetic femur fractures with curved non-locking plate with eccentric holes: Retrospective study of 43 patients with minimum 1-year follow-up. Orthop Traumatol Surg Res. 2015 May;101(3):277-82.
12- Brodén, C., Mukka, S., Muren, O., Eisler, T., Boden, H., Stark, A., et al. High risk of early periprosthetic fractures after primary hip arthroplasty in elderly patients using a cemented, tapered, polished stem: An observational, prospective cohort study on 1,403 hips with 47 fractures after mean follow-up time of 4 years. Acta Orthopaedica. 2015;86(2):169-174.
13- Singh JA, Jensen MR, Harmsen SW, Lewallen DG. Are gender, comorbidity, and obesity risk factors for postoperative periprosthetic fractures after primary total hip arthroplasty?. J Arthroplasty. 2013 Jan;28(1):126-31.e1-2.
14- Füchtmeier B, Galler M, Müller F. Mid-Term Results of 121 Periprosthetic Femoral Fractures: Increased Failure and Mortality Within but not After One Postoperative Year. J Arthroplasty. 2015 Apr;30(4):669-74.
15- Märdian S, Schaser KD, Gruner J, Scheel F, Perka C, Schwabe P. Adequate surgical treatment of periprosthetic femoral fractures following hip arthroplasty does not correlate with functional outcome and quality of life. Int Orthop. 2015 Sep;39(9):1701-8.
16- Toogood PA, Vail TP. Periprosthetic Fractures: A Common Problem with a Disproportionately High Impact on Healthcare Resources. J Arthroplasty. 2015 Oct;30(10):1688-91.
17- Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S200-7.
18- Kobbe P, Klemm R, Reilmann H, Hockertz TJ. Less invasive stabilisation system (LISS) for the treatment of periprosthetic femoral fractures: a 3-year follow-up. Injury. 2008 Apr;39(4):472-9.
19- Zuurmond RG , van Wijhe W, van Raay JJ, Bulstra SK. High incidence of complications and poor clinical outcome in the operative treatment of periprosthetic femoral fractures: An analysis of 71 cases. Injury. 2010 Jun;41(6):629-33.
20- Park MS, Lim YJ, Chung WC, Ham DH, Lee SH. Management of periprosthetic femur fractures treated with distal fixation using a modular femoral stem using an anterolateral approach. J Arthroplasty. 2009 Dec;24(8):1270-6.
21- Mulay S, Hassan T, Birtwistle S, Power R. Management of types B2 and B3 femoral periprosthetic fractures by a tapered, fluted, and distally fixed stem. J Arthroplasty. 2005 Sep;20(6):751-6.
22- Corten K, Vanrykel F, Bellemans J, Frederix PR, Simon JP, Broos PL. An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component. J Bone Joint Surg Br. 2009 Nov;91(11):1424-30.
23- Lindahl H, Malchau H, Odén A, Garellick G. Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br. 2006 Jan;88(1):26-30.
24- Pavlou G, Panteliadis P, Macdonald D, Timperley JA, Gie G, Bancroft G, Tsiridis E. A review of 202 periprosthetic fractures--stem revision and allograft improves outcome for type B fractures. Hip Int. 2011 Jan-Mar;21(1):21-9.
25- Corten K, Macdonald SJ, McCalden RW, Bourne RB, Naudie DD. Results of cemented femoral revisions for periprosthetic femoral fractures in the elderly. J Arthroplasty. 2012 Feb;27(2):220-5.
Moore RE, Baldwin K, Austin MS3, Mehta S. A systematic review of open reduction and internal fixation of periprosthetic femur fractures with or without allograft strut, cerclage, and locked plates. J Arthroplasty. 2014 May;29(5):872-6.
26- Bhattacharyya T, Chang D, Meigs JB, Estok DM 2nd, Malchau H. Mortality after periprosthetic fracture of the femur. J Bone Joint Surg Am. 2007 Dec;89(12):2658-62.
27- Streubel PN. Mortality after periprosthetic femur fractures. J Knee Surg. 2013 Feb;26(1):27-30.
28- Spina M, Rocca G, Canella A, Scalvi A. Causes of failure in periprosthetic fractures of the hip at 1- to 14-year follow-up. Injury. 2014 Dec;45 Suppl 6:S85-92.
29- Langenhan R, Trobisch P, Ricart P, Probst A. Aggressive surgical treatment of periprosthetic femur fractures can reduce mortality: comparison of open reduction and internal fixation versus a modular prosthesis nail. J Orthop Trauma 2012;26(2):80–85
30- Kinov P, Volpin G, Sevi R, Tanchev PP, Antonov B, Hakim G. Surgical treatment of periprosthetic femoral fractures following hip arthroplasty: our institutional experience. Injury. 2015 Oct;46(10):1945-50.