Manuel Becerra¹, Héctor Foncea^1*, Carolina Becerra², Leonardo Villarroel¹, Nicolás Rojas¹, Sebastián Cuellar¹, Paulo Villarroel¹ and Enrique Cifuentes¹

¹Department of Orthopedic Surgery, Traumatological Institute, Chile
²University of Valparaiso, Chile

*Corresponding Author: Héctor Foncea Department of Orthopedic Surgery, Traumatological Institute, Chile.

Received: May 23, 2024; Published: June 18, 2024

Abstract

Introduction: Periprosthetic fractures (PPF) are those that occur around a prosthesis, being a catastrophic complication. They are the fourth most frequent cause of hip surgery revisions, accounting for 9.9% of cases in the Australian registry. Its treatment is complex and the results are often poor with high morbidity and mortality rates.

Objective: To perform a descriptive analysis and identify factors associated with the results in patients operated on for hip PPF.

Materials and Methods: A retrospective study was carried out by obtaining data from patients operated on for PPF between January 2015 and December 2019 in a public hospital in the central area of Chile. Patients of all ages with femoral or acetabular fracture related to previous total hip arthroplasty (TCA) were included. Patients with arthroplasty due to tumor causes were excluded. Demographic, clinical, and radiographic data were obtained from the clinical record, and patients were cataloged according to their independence to move around as a measure of functional capacity. The results were analyzed using statistical models, hypothesis tests and machine learning models.

Results: A total of 53 patients with PPF were identified between the period described. 79.2% were women and 20.8% men, with a mean age of 76.8 years. The most frequent fractures, according to the Vancouver classification, were B1 (41.5%), followed by B2 (32.1%) and FA (11.3%). All fractures were explained by a low-energy mechanism. The initial indication for CTA was femoral neck fracture in 47.2% of cases, followed by hip osteoarthritis (41.5%). A difference was observed between the time between CTA and PPF, being lower for patients with hypertension and type 2 diabetes mellitus (mean 2 years) compared to patients without comorbidities (mean 9.5 years). The treatment of choice was reduction and osteosynthesis in 49% of cases and prosthetic replacement in the remaining percentage. A longer hospitalization period for PPF was significantly correlated with higher incidence of infection, with worse functional outcomes. The average follow-up was 23 months and after rehabilitation, 20.8% managed to walk without technical aids, 34% walked with assistance, 24.5% moved only in a wheelchair and 7.5% ended up bedridden. There were no patients with B3 or C fractures who managed to return to their previous ability to move, and all bedridden patients presented after a B1 fracture. When performing a decision tree model, the most relevant variables to arrive at the different functional outcomes were pain, cementation, years between surgery and PPF, days of hospitalization, and gender. The analyses of the importance of variables revealed that those that best explained the dispersion of the data were type of review, functionality, number of previous surgeries and time between PPF and surgery. At the end of follow-up, 32.1% of patients had died.

Conclusion: PPF occurred in a shorter period of time since the last surgery in patients with type 2 diabetes mellitus and arterial hypertension compared to those without comorbidities. A longer hospitalization time was correlated with greater infection of the new implant and worse prognosis. Walking ability was seriously impaired in a large percentage of patients. We found variables that could explain the large dispersion of the data. Our results were similar to those reported in the literature and give rise to further studies on the identified variables.

Keywords: Hip Fractures; Joint Revision; Periprosthetic Fracture

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Citation

Citation: Héctor Foncea., et al. “Descriptive Analysis and Results of Patients Operated on for Periprosthetic Hip Fracture".Acta Scientific Orthopaedics 7.7 (2024): 07-13.

Copyright

Copyright: © 2024 Héctor Foncea., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.