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Archives of Orthopaedic and Trauma Surgery

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01-04-2016 | Trauma Surgery

The influence of the operation technique and implant used in the treatment of periprosthetic hip and interprosthetic femur fractures: a systematic literature review of 1571 cases

Authors: Karl Stoffel, Christoph Sommer, Vasiliki Kalampoki, Andrea Blumenthal, Alexander Joeris

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 4/2016

Abstract

Introduction

A systematic literature review on periprosthetic/interprosthetic fracture fixation after hip arthroplasties was performed to summarize available clinical data. Operation techniques and implants used were evaluated as possible risk factors for outcomes.

Materials and methods

MEDLINE and Cochrane databases were searched. Articles describing patients with postoperative periprosthetic femur fractures sustained around a hip arthroplasty and with interprosthetic fractures treated with plates, nails, screws and/or cerclage were included. Considered articles were from 2000 or newer. Eligible abstracts were screened by two independent persons and discrepancies were resolved by consensus. Absolute numbers of complications and/or reoperation events along with their corresponding rates were calculated according to operation technique and type of implant. Relative risks of having a complication and/or a reoperation according to the operation technique and the type of implant used were estimated.

Results

Available data from 49 prospective and retrospective studies were analyzed. Of 1574 fractures, 81.7 % were treated with plating. For 83.0 % of all fractures, an open approach was applied. The overall complication rate was 14.3 %. Fixation failure and nonunion were most often reported (fixation failure: 4.4 %; nonunion: 3.9 %). Nonunion and refracture occurred more often after open approaches than after minimal invasive osteosynthesis (nonunion: 4.5 vs. 0.0 %, p = 0.001; refracture: 3.8 vs. 0.6 %. p = 0.024). The relative risk for nonunion was 11.9 (95 % CI 4.5–31.5) times higher (p < 0.0001) for non-locking plates (13.0 %) than for locking plates (1.1 %).

Conclusions

The clinical evidence of published studies dealing with periprosthetic/interprosthetic fractures after hip arthroplasty is generally low. This literature search suggested higher rates of nonunion and refracture after an open approach and a higher risk of nonunion for non-locking plates compared to locking plates. Based on the available clinical evidence, no treatment recommendations can be given.

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Title: The influence of the operation technique and implant used in the treatment of periprosthetic hip and interprosthetic femur fractures: a systematic literature review of 1571 cases
Authors: Karl Stoffel
Christoph Sommer
Vasiliki Kalampoki
Andrea Blumenthal
Alexander Joeris
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 4/2016
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-016-2407-y

At a glance: The STEP trials

Springer Medicine

The influence of the operation technique and implant used in the treatment of periprosthetic hip and interprosthetic femur fractures: a systematic literature review of 1571 cases

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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