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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 3/2022

Open Access 12-11-2021 | Femoral Fracture | Original Article

Revision rate is higher in patients with periprosthetic femur fractures following revision arthroplasty in comparison with ORIF following our algorithm: a two-center 1 analysis of 129 patients

Authors: Patrick Pflüger, Eftychios Bolierakis, Markus Wurm, Klemens Horst, Frank Hildebrand, Peter Biberthaler

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2022

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Abstract

Purpose

Effective therapy of periprosthetic femur fractures of the hip (PPF) are challenging due to patients’ frailty and complexity of fracture patterns. The aim of this cohort study was to analyze the radiological and functional outcome following PPF.

Methods

A retrospective, multicenter study in the period 2009–2019 of patients with PPF at two level I trauma centers in Germany was performed. PPF were classified according to the Vancouver classification system. Demographic data, American Society of Anesthesiologists (ASA) classification, type of surgery, complications, and reoperation rate were obtained from patient records. The functional outcome was assessed by the modified Harris-Hip Score (mHHS), general health using the EQ-5D, and radiological outcome by Beals & Tower (B&T) criteria.

Results

A total of 129 patients with a mean age of 79 years (range 43–102) were included. 70% of all patients were female and 68% of the patients had an ASA score ≥ 3. 20 patients suffered from a Vancouver A, 90 from a Vancouver B and 19 from a Vancouver C fracture. 14% of the patients died within the first 2 years after surgery. The reoperation rate after open reduction and internal fixation (ORIF) (n = 60) was 8% and after revision arthroplasty (RA) (n = 47) 30% (OR 3.4, 95% CI [1.21–10.2]). Mean mHHS (n = 32) was 53 ± 19.4 and EQ-VAS was 50 ± 24.6. According to B&T criteria, 82% of patients treated with ORIF (n = 17) and 62% after RA (n = 13) showed an excellent outcome.

Conclusion

Patients with a PPF of the hip are elderly and at increased operative risk. In cases with a stable prosthesis, ORIF provides good radiological outcome with low reoperation rates. In case of RA, the risk for revision surgery is higher.
Literature
1.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. JBJS. 2007;89(4):780–5.CrossRef
2.
Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007;38(6):651–4.CrossRef
3.
4.
Bhattacharyya T, Chang D, Meigs JB, Estok DM, Malchau H. Mortality after periprosthetic fracture of the femur. JBJS. 2007;89(12):2658–62.CrossRef
5.
Moreta J, Aguirre U, de Ugarte OS, Jáuregui I, Martínez-De Los Mozos JL. Functional and radiological outcome of periprosthetic femoral fractures after hip arthroplasty. Injury. 2015;46(2):292–8.CrossRef
6.
Hoellwarth JS, Fourman MS, Crossett L, et al. Equivalent mortality and complication rates following periprosthetic distal femur fractures managed with either lateral locked plating or a distal femoral replacement. Injury. 2018;49(2):392–7.CrossRef
7.
Corten K, Vanrykel F, Bellemans J, Frederix PR, Simon J-P, Broos P. An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component. J Bone Jt Surg Br Vol. 2009;91(11):1424–30.CrossRef
8.
Pike JM, Grewal R, Athwal GS, Faber KJ, King GJ. Open reduction and internal fixation of radial head fractures: do outcomes differ between simple and complex injuries? Clin Orthop Relat Res. 2014;472(7):2120–7.CrossRef
9.
Brady OH, Garbuz DS, Masri BA, Duncan CP. Classification of the hip. Orthop Clin. 1999;30(2):215–20.
10.
Patsiogiannis N, Kanakaris NK, Giannoudis PV. Periprosthetic hip fractures: an update into their management and clinical outcomes. EFORT Open Rev. 2021;6(1):955–72.CrossRef
11.
Duncan C, Haddad F. The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Jt J. 2014;96(6):713–6.CrossRef
12.
Jennison T, Jawed A, ElBakoury A, Hosny H, Yarlagadda R. Reliability of the commonly used classification systems for interprosthetic fractures. Eur J Orthop Surg Traumatol. 2019;29(5):1069–72.CrossRef
13.
Kanakaris NK, Obakponovwe O, Krkovic M, et al. Fixation of periprosthetic or osteoporotic distal femoral fractures with locking plates: a pilot randomised controlled trial. Int Orthop. 2019;43(5):1193–204.CrossRef
14.
Khan T, Grindlay D, Ollivere B, Scammell BE, Manktelow A, Pearson RG. A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Jt J. 2017;99(4 Suppl B):7–25.
15.
Ruchholtz S, El-Zayat B, Kreslo D, et al. Less invasive polyaxial locking plate fixation in periprosthetic and peri-implant fractures of the femur—a prospective study of 41 patients. Injury. 2013;44(2):239–48.CrossRef
16.
Fink B, Oremek D. Hip revision arthroplasty for failed osteosynthesis in periprosthetic Vancouver type B1 fractures using a cementless, modular, tapered revision stem. Bone Jt J. 2017;99(4 Supple B):11–6.CrossRef
17.
Engh CA, Glassman AH, Suthers KE. The case for porous-coated hip implants. The femoral side. Clin Orthop Relat Res. 1990;261:63–81.CrossRef
18.
19.
Beals RK, Tower SS. Periprosthetic fractures of the femur: an analysis of 93 fractures. Clin Orthop Relat Res. 1996;327:238–46.CrossRef
20.
Heyes G, Tucker A, Marley D, Foster A. Predictors for 1-year mortality following hip fracture: a retrospective review of 465 consecutive patients. Eur J Trauma Emerg Surg. 2017;43(1):113–9.CrossRef
21.
Joestl J, Hofbauer M, 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;47(4):939–43.CrossRef
22.
Finlayson G, Tucker A, Black ND, McDonald S, Molloy M, Wilson D. Outcomes and predictors of mortality following periprosthethic proximal femoral fractures. Injury. 2019;50(2):438–43.CrossRef
23.
Hadji P, Klein S, Gothe H, et al. The epidemiology of osteoporosis—Bone Evaluation Study (BEST): an analysis of routine health insurance data. Dtsch Arztebl Int. 2013;110(4):52.PubMedPubMedCentral
24.
25.
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;30(4):669–74.CrossRef
26.
27.
Abdel M, Watts C, Houdek M, Lewallen D, Berry D. Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Jt J. 2016;98(4):461–7.CrossRef
28.
Carli A, Negus J, Haddad F. Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture. Bone Jt J. 2017;99(1_Supple_A):50–9.CrossRef
29.
Drew JM, Griffin WL, Odum SM, Van Doren B, Weston BT, Stryker LS. Survivorship after periprosthetic femur fracture: factors affecting outcome. J Arthroplasty. 2016;31(6):1283–8.CrossRef
30.
31.
Niikura T, Lee SY, Sakai Y, Nishida K, Kuroda R, Kurosaka M. Treatment results of a periprosthetic femoral fracture case series: treatment method for Vancouver type b2 fractures can be customized. Clin Orthop Surg. 2014;6(2):138–45.CrossRef
32.
Solomon LB, Hussenbocus SM, Carbone TA, Callary SA, Howie DW. Is internal fixation alone advantageous in selected B 2 periprosthetic fractures? ANZ J Surg. 2015;85(3):169–73.CrossRef
33.
Baum C, Leimbacher M, Kriechling P, Platz A, Cadosch D. Treatment of periprosthetic femoral fractures vancouver type b2: revision arthroplasty versus open reduction and internal fixation with locking compression plate. Geriatr Orthop Surg Rehab. 2019;10:2151459319876859.
34.
Lindahl H, Garellick G, Regnér H, Herberts P, Malchau H. Three hundred and twenty-one periprosthetic femoral fractures. JBJS. 2006;88(6):1215–22.CrossRef
35.
Zuurmond R, Van Wijhe W, van Raay J, Bulstra S. High incidence of complications and poor clinical outcome in the operative treatment of periprosthetic femoral fractures: an analysis of 71 cases. Injury. 2010;41(6):629–33.CrossRef
Metadata
Title
Revision rate is higher in patients with periprosthetic femur fractures following revision arthroplasty in comparison with ORIF following our algorithm: a two-center 1 analysis of 129 patients
Authors
Patrick Pflüger
Eftychios Bolierakis
Markus Wurm
Klemens Horst
Frank Hildebrand
Peter Biberthaler
Publication date
12-11-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-021-01832-8

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