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 (THA) 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 THA 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

References

1. Boylan MR., et al. “Mortality following periprosthetic proximal femoral fractures versus native hip fractures”. The Journal of Bone and Joint Surgery American Volume 100 (2018): 578-585.
2. Berry DJ. “Epidemiology: hip and knee”. Orthopedic Clinics of North America 30 (1999): 183-190.
3. Morrey BF and Kavanagh BF. “Complications with revision of the femoral component of total hip arthroplasty: comparison between cemented and uncemented techniques”. The Journal of Arthroplasty 7 (1992): 71-79.
4. Cox JS., et al. “Frequency and treatment trends for periprosthetic fractures about total hip arthroplasty in the United States”. The Journal of Arthroplasty9 (1999): 115-120.
5. Pivec R., et al. “Incidence and future projections of periprosthetic femoral fracture following primary total hip arthroplasty: an analysis of international registry data”. Journal of Long-Term Effects of Medical Implants 25 (2015): 269-275.
6. Singh JA., et al. “Are gender, comorbidity and obesity risk factors for postoperative periprosthetic fractures following primary total hip replacement?” The Journal of Arthroplasty 28 (2013): 126-131.
7. Ahuja S and Chatterji S. “The Mennen femoral plate for fixation of periprosthetic femoral fractures following hip arthroplasty”. Injury1 (2002): 47-50.
8. Beals RK and Tower SS. “Periprosthetic fractures of the femur. An analysis of 93 fractures”. Clinical Orthopaedics and Related Research^® 327 (1996): 238-246.
9. Fredin HO., et al. “Femoral fracture following hip arthroplasty”. Acta Orthopaedica Scandinavica1 (1987): 20-22.
10. Pascarella R., et al. “Periprosthetic acetabular fractures: a new classification proposal”. Injury 49 (2018): S65-S73.
11. Lindahl H. “Epidemiology of periprosthetic femur fracture around a total hip arthroplasty”. Injury 38 (2007): 651-654.
12. Lindahl H., et al. “Three hundred and twenty-one periprosthetic femoral fractures”. The Journal of Bone and Joint Surgery American Volume 6 (2006): 1215-1222.
13. Wu CC., et al. “Risk factors for postoperative femoral fracture in cementless hip arthroplasty”. Journal of the Formosan Medical Association 98 (1999): 190-194.
14. Tsiridis E., et al. “The management of periprosthetic femoral fractures around hip replacements”. Injury 34 (2003): 95-105.
15. Lindahl H., et al. “Risk factors for failure after treatment of a periprosthetic fracture of the femur”. The Journal of Bone and Joint Surgery British Volume 88 (2006): 26-30.
16. Franklin J and Malchau H. “Risk factors for periprosthetic femoral fracture”. Injury 38 (2018): 655-660.
17. Duncan CP and Masri BA. “Fractures of the femur after hip replacement”. Instructional Course Lectures 44 (1995): 293-304.
18. Joestl J., et al. “Locking compression plate versus revision-prosthesis for Vancouver type B2 periprosthetic femoral fractures after total hip arthroplasty”. Injury 47 (2016): 939-943.
19. Corten K., et al. “An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component”. The Journal of Bone and Joint Surgery British Volume 91 (2009): 1424-1430.
20. Lindahl H., et al. “Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register”. The Journal of Arthroplasty 20 (2005): 857-865.
21. Callaghan JJ., et al. “Periprosthetic fractures of the acetabulum”. Orthopedic Clinics of North America 30 (1999): 221-234.
22. Resch H., et al. “Treatment of periprosthetic acetabular fractures after previous hemi- or total hip arthroplasty: Introduction of a new implant”. Operative Orthopädie und Traumatologie 28 (2016): 104-110.
23. Griffiths EJ., et al. “Time to surgery and 30-day morbidity and mortality of periprosthetic hip fractures”. Injury 44 (2013): 1949-1952.
24. Moreta J., et al. “Functional and radiological outcome of periprosthetic femoral fractures after hip arthroplasty”. Injury 46 (2015): 292-298.
25. Bethea JS., et al. “Proximal femoral fractures following total hip arthroplasty”. Clinical Orthopaedics 170 (1982): 95-106.
26. Schwartz JT., et al. “Femoral fracture during non-cemented total hip arthroplasty”. The Journal of Bone and Joint Surgery American Volume 71 (1989): 1135-1142.
27. Carli AV., et al. “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 Joint 99-B (2017): 50-59.
28. Kärrholm J. “The Swedish Hip Arthroplasty Register”. Acta Orthopaedica81 (2010): 3-4.
29. Zuurmond RG., et al. “High incidence of complications and poor clinical outcome in the operative treatment of periprosthetic femoral fractures: an analysis of 71 cases”. Injury 41 (2010): 629-633.
30. Young SW., et al. “Functional outcome of femoral peri prosthetic fracture and revision hip arthroplasty: a matched-pair study from the New Zealand Registry”. Acta Orthopaedica79 (2008): 483-488.

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.