Top

25-09-2024 | Femoral Fracture | Original Paper

Usefulness of non-surgical treatment without weight bearing restriction versus surgical treatment for maintaining activities of daily living in patients with peri-prosthetic femoral fractures

Authors: Hideki Ueyama, Mitsuyoshi Yamamura, Junichiro Koyanagi, Kenji Fukunaga, Susumu Takemura, Suguru Nakamura

Published in: International Orthopaedics

Abstract

Purpose

Non-surgical treatment without weight-bearing restriction, even in the early post-injury phase, may have a favourable effect on the activities of daily living (ADLs) in elderly patients with peri-prosthetic femoral fractures (PFFs). This study aimed to assess the effectiveness of surgical and non-surgical treatments for PFFs in terms of ADL maintenance and clinical safety.

Methods

This retrospective cohort study included 44 patients with PFFs proximal to the stem fixation site without stem loosening. Rehabilitation with weight bearing was initiated after internal fixation of the fracture site in the surgical group (n = 12) and immediately after the injury in the non-surgical group (n = 32). Clinical and radiological outcomes, including time until the first weight-bearing exercise, time until independent walking, ADL deterioration, and bone union rate, were compared between groups. Independent risk factors for ADL deterioration were also evaluated.

Results

The time until first weight-bearing exercise was shorter and the ADL deterioration rate was smaller in the non-surgical group than in the surgical group (8.8 ± 9.2 vs. 21 ± 13 days, P = 0.004; 6.2% vs. 12.5%, P = 0.04, respectively). Bone union rates were similar between groups (91% vs. 83%, P = 0.42), and aseptic loosening of the stem was not observed. Time until first weight-bearing exercise was identified as an independent risk factor for ADL deterioration (odds ratio, 1.13; 95% confidence interval, 1.01–1.26; P = 0.03).

Conclusion

Non-surgical treatment of PFFs proximal to the stem fixation site without stem loosening, which does not restrict early weight-bearing exercise after injury, is an effective and safe treatment procedure that maintains ADL performance in elderly patients.

Dwyer-Lindgren L, Kendrick P, Kelly YO et al (2022) Life expectancy by county, race, and ethnicity in the USA, 2000–19: a systematic analysis of health disparities. Lancet 400:25–38. https://doi.org/10.1016/S0140-6736(22)00876-5CrossRef

Sershon RA, McDonald JF, Ho H, Hamilton WG (2021) Periprosthetic femur fracture risk: influenced by Stem Choice, Not Surgical Approach. J Arthroplasty 36:S363–S366. https://doi.org/10.1016/j.arth.2021.02.012CrossRefPubMed

Shichman I, Roof M, Askew N et al (2023) Projections and epidemiology of primary hip and knee arthroplasty in Medicare patients to 2040–2060. JB JS open Access 8:101152. https://doi.org/10.2106/JBJS.OA.22.00112CrossRef

Di Girolamo FG, Fiotti N, Milanović Z et al (2021) The aging muscle in experimental Bed Rest: a systematic review and Meta-analysis. Front Nutr 8:633987. https://doi.org/10.3389/fnut.2021.633987CrossRefPubMedPubMedCentral

Ferrucci L, Guralnik JM, Pahor M et al (1997) Hospital diagnoses, Medicare charges, and nursing home admissions in the year when older persons become severely disabled. JAMA 277:728–734CrossRefPubMed

Haider T, Hanna P, Mohamadi A et al (2021) Revision arthroplasty Versus Open reduction and internal fixation of Vancouver Type-B2 and B3 periprosthetic femoral fractures. JBJS Rev 9:1–10. https://doi.org/10.2106/JBJS.RVW.21.00008CrossRef

Stoffel K, Blauth M, Joeris A et al (2020) Fracture fixation versus revision arthroplasty in Vancouver type B2 and B3 periprosthetic femoral fractures: a systematic review. Arch Orthop Trauma Surg 140:1381–1394. https://doi.org/10.1007/s00402-020-03332-7CrossRefPubMedPubMedCentral

Scott MJ, Baldini G, Fearon KCH et al (2015) Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations. Acta Anaesthesiol Scand 59:1212–1231. https://doi.org/10.1111/aas.12601CrossRefPubMedPubMedCentral

Aldinger PR, Jung AW, Pritsch M et al (2009) Uncemented grit-blasted straight tapered titanium stems in patients younger than fifty-five years of age. Fifteen to twenty-year results. J Bone Joint Surg Am 91:1432–1439. https://doi.org/10.2106/JBJS.H.00297CrossRefPubMed

10.

Harris WH, McCarthy JCJ, O’Neill DA (1982) Femoral component loosening using contemporary techniques of femoral cement fixation. J Bone Joint Surg Am 64:1063–1067CrossRefPubMed

11.

Zhang Q, Goodman SB, Maloney WJ, Huddleston JI (2016) Can a Conical Implant successfully address Complex anatomy in primary THA? Radiographs and hip scores at early followup. Clin Orthop Relat Res 474:459–464. https://doi.org/10.1007/s11999-015-4480-xCrossRefPubMed

12.

Preston E, Ada L, Stanton R et al (2021) Prediction of independent walking in people who are nonambulatory early after stroke: a systematic review. Stroke 52:3217–3224. https://doi.org/10.1161/STROKEAHA.120.032345CrossRefPubMed

13.

Kostenuik P, Mirza FM (2017) Fracture healing physiology and the quest for therapies for delayed healing and nonunion. J Orthop Res 35:213–223. https://doi.org/10.1002/jor.23460CrossRefPubMed

14.

Beals RK, Tower SS (1996) Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res 327:238–246. https://doi.org/10.1097/00003086-199606000-00029CrossRef

15.

Pavlou M, Ambler G, Seaman SR et al (2015) How to develop a more accurate risk prediction model when there are few events. BMJ 351:7–11. https://doi.org/10.1136/bmj.h3868CrossRef

16.

Masri BA, Meek RMD, Duncan CP (2004) Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 80–95. https://doi.org/10.1097/00003086-200403000-00012

17.

Lee YK, Kim JT, Kim KC et al (2017) Conservative treatment for minimally displaced type B periprosthetic femoral fractures. J Arthroplasty 32:3529–3532. https://doi.org/10.1016/j.arth.2017.05.057CrossRefPubMed

18.

Kortebein P, Ferrando A, Lombeida J et al (2007) Effect of 10 days of Bed rest on skeletal muscle in healthy older adults. JAMA 297:1769. https://doi.org/10.1001/jama.297.16.1772-bCrossRef

19.

Schiaffino S, Dyar KA, Ciciliot S et al (2013) Mechanisms regulating skeletal muscle growth and atrophy. FEBS J 280:4294–4314. https://doi.org/10.1111/febs.12253CrossRefPubMed

20.

Ueyama H, Yamamura M, Koyanagi J et al (2024) Early postoperative functional recovery in older patients with periprosthetic femoral fractures: comparison between cemented and Cementless Stem revisions. Arthroplast Today 28:101467. https://doi.org/10.1016/j.artd.2024.101467CrossRefPubMedPubMedCentral

21.

Skou ST, Juhl CB, Hare KB et al (2020) Surgical or non-surgical treatment of traumatic skeletal fractures in adults: systematic review and meta-analysis of benefits and harms. Syst Rev 9:179. https://doi.org/10.1186/s13643-020-01424-4CrossRefPubMedPubMedCentral

22.

Chethan KN, Zuber M, Bhat NS et al (2019) Static structural analysis of different stem designs used in total hip arthroplasty using finite element method. Heliyon 5:e01767. https://doi.org/10.1016/j.heliyon.2019.e01767CrossRef

23.

Jin X, Li Y, Yang Y et al (2022) Thioacetamide promotes osteoclast transformation of bone marrow macrophages by influencing PI3K/AKT pathways. J Orthop Surg Res 17:53. https://doi.org/10.1186/s13018-022-02938-4CrossRefPubMedPubMedCentral

24.

Çelik T, Kişioğlu Y (2019) Evaluation of new hip prosthesis design with finite element analysis. Australas Phys Eng Sci Med 42:1033–1038. https://doi.org/10.1007/s13246-019-00802-0CrossRefPubMed

25.

Radaelli M, Buchalter DB, Mont MA et al (2023) A new classification system for Cementless femoral stems in total hip arthroplasty. J Arthroplasty 38:502–510. https://doi.org/10.1016/j.arth.2022.09.014CrossRefPubMed

Title: Usefulness of non-surgical treatment without weight bearing restriction versus surgical treatment for maintaining activities of daily living in patients with peri-prosthetic femoral fractures
Authors: Hideki Ueyama
Mitsuyoshi Yamamura
Junichiro Koyanagi
Kenji Fukunaga
Susumu Takemura
Suguru Nakamura
Publication date: 25-09-2024
Publisher: Springer Berlin Heidelberg
Keyword: Femoral Fracture
Published in: International Orthopaedics
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-024-06331-0

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Usefulness of non-surgical treatment without weight bearing restriction versus surgical treatment for maintaining activities of daily living in patients with peri-prosthetic femoral fractures

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content