Fracture pattern and risk factors for reoperation after treatment of 156 periprosthetic fractures around an anatomic cemented hip stem
DOI:
https://doi.org/10.2340/17453674.2023.18263Keywords:
Canal thickness ratio, Cemented femoral stem, Lubinus SP2 stem, PPFF, Remaining Attachment Index, Total hip replacementAbstract
Background and purpose: The Lubinus SP2 stem has been associated with a very low risk of periprosthetic femoral fractures (PPFFs). We aimed, primarily, to study the radiographic morphology of PPFFs close to a Lubinus SP2 stem. Secondarily, we analyzed whether higher reoperation rate was correlated to the revision method chosen or to the characteristics of the fracture and of the bone.
Patients and methods: The study included 156 femoral fractures close to a Lubinus cemented stem. These fractures were treated in 40 hospitals in Sweden between 2006 and 2011 and were followed up until 2019. Data from the Swedish Arthroplasty Register was used. Medical records and radiographs were studied. The fractures were classified according to the Vancouver classification. The fracture location and anatomy were delineated. We also measured the remaining attachment index (RAI) and the canal thickness ratio.
Results: Vancouver type C (n = 101) and spiral fractures (n = 67, 41 in Vancouver C and 26 in Vancouver B) were the most common fracture types. 4 fractures were avulsion of the greater trochanter. The remaining 51 fractures occurred around the stem (B1: 25, B2: 16, and B3: 10). B fractures were more commonly reoperated on (18 of 51, 35%) than type C fractures (11 of 101, 11%, P = 0.001). In most femurs with type B3 fracture, the fracture line covered an area only around the stem, but in all B1 and in 11 of 16 B2 fractures, it was extended even distal to the stem. ORIF instead of stem revision in B2 fractures, use of short stems or plates, and inadequate reduction of the fractures were risk factors for subsequent reoperations.
Conclusion: The higher reoperation rate in type B fractures, compared with fractures distal to the stem, could be caused by their higher degree of complexity and reduced capacity for healing in the region around the stem.
Downloads
References
Cnudde P, Bulow E, Nemes S, Tyson Y, Mohaddes M, Rolfson O. Association between patient survival following reoperation after total hip replacement and the reason for reoperation: an analysis of 9,926 patients in the Swedish Hip Arthroplasty Register. Acta Orthop 2019; 90(3): 226-30. doi: 10.1080/17453674.2019.1597062. DOI: https://doi.org/10.1080/17453674.2019.1597062
Thien T M, Chatziagorou G, Garellick G, Furnes O, Havelin L I, Mäkelä K, et al. Periprosthetic femoral fracture within two years after total hip replacement: analysis of 437,629 operations in the nordic arthroplasty register association database. J Bone Joint Surg Am 2014; 96(19): e167. doi: 10.2106/JBJS.M.00643. DOI: https://doi.org/10.2106/JBJS.M.00643
Chatziagorou G, Lindahl H, Garellick G, Kärrholm J. Incidence and demographics of 1751 surgically treated periprosthetic femoral fractures around a primary hip prosthesis. Hip Int 2019; 29(3): 282-8. doi: 10.1177/1120700018779558. DOI: https://doi.org/10.1177/1120700018779558
Abdel M P, Watts C D, Houdek M T, Lewallen D G, Berry D J. Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Joint J 2016; 98-b(4): 461-7. doi: 10.1302/0301-620x.98b4.37201. DOI: https://doi.org/10.1302/0301-620X.98B4.37201
Lindberg-Larsen M, Petersen P B, Jørgensen C C, Overgaard S, Kehlet H. Postoperative 30-day complications after cemented/hybrid versus cementless total hip arthroplasty in osteoarthritis patients > 70 years. Acta Orthop 2020; 91(3): 286-92. doi: 10.1080/17453674.2020.1745420. DOI: https://doi.org/10.1080/17453674.2020.1745420
SHAR. Svenska Höftprotesregistret. Årsrapport 2019; 2020. https://registercentrum.blob.core.windows.net/slr/r/2019-B1xpWMUSPO.pdf
Chatziagorou G, Lindahl H, Kärrholm J. The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems. Acta Orthop 2019; 90(2): 135-42. doi: 10.1080/17453674.2019.1574387. DOI: https://doi.org/10.1080/17453674.2019.1574387
Erhardt J B, Khoo P P, Stoffel K K, Yates P J. Periprosthetic fractures around polished collarless cemented stems: the effect of stem design on fracture pattern. Hip Int 2013; 23(5): 459-64. doi: 10.5301/hipint.5000052. DOI: https://doi.org/10.5301/hipint.5000052
Leonidou A, Moazen M, Skrzypiec D M, Graham S M, Pagkalos J, Tsiridis E. Evaluation of fracture topography and bone quality in periprosthetic femoral fractures: a preliminary radiographic study of consecutive clinical data. Injury 2013; 44(12): 1799-804. doi: 10.1016/j.injury.2013.08.010. DOI: https://doi.org/10.1016/j.injury.2013.08.010
Powell-Bowns M F R, Oag E, Martin D, Clement N D, Scott C E H. Vancouver B and C periprosthetic fractures around the cemented Exeter Stem: sex is associated with fracture pattern. Arch Orthop Trauma Surg 2022; 142(11): 3221-8. doi: 10.1007/s00402-021-04113-6.
Katz J N, Wright E A, Polaris J J, Harris M B, Losina E. Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study. BMC Musculoskelet Disord 2014; 15: 168. doi: 10.1186/1471-2474-15-168. DOI: https://doi.org/10.1186/1471-2474-15-168
Chatziagorou G, Lindahl H, Kärrholm J. Surgical treatment of Vancouver type B periprosthetic femoral fractures: patient characteristics and outcomes of 1381 fractures treated in Sweden between 2001 and 2011. Bone Joint J 2019; 101-b(11): 1447-58. doi: 10.1302/0301-620x.101b11.bjj-2019-0480.r2. DOI: https://doi.org/10.1302/0301-620X.101B11.BJJ-2019-0480.R2
Duncan C P, Masri B A. Fractures of the femur after hip replacement. Instr Course Lect 1995; 44: 293-304. PMID: 7797866
Duncan C P, Haddad F S. Unified Classification System (UCS). Periprosthetic Fracture Management: Thieme; 2013. pp 47-57.
Andriamananaivo T, Odri G A, Ollivier M, Mattesi L, Renault A, Rongieras F, et al. Contribution of the remaining attachment index in the management of Vancouver B1 periprosthetic hip fracture. Orthop Traumatol Surg Res 2020; 106(7): 1413-17. doi: 10.1016/j.otsr.2020.06.016. DOI: https://doi.org/10.1016/j.otsr.2020.06.016
Molina V, Da S C, Court C, Nordin J Y. [Periprosthetic fractures around total hip and knee arthroplasty. Periprosthetic femoral fractures: multicentric retrospective study of 580 cases]. Rev Chir Orthop Reparatrice Appar Mot 2006; 92(5 Suppl.): 2s60-2s4. PMID: 17802658.
Morishima T, Ginsel B L, Choy G G, Wilson L J, Whitehouse S L, Crawford R W. Periprosthetic fracture torque for short versus standard cemented hip stems: an experimental in vitro study. J Arthroplasty 2014; 29(5): 1067-71. doi: 10.1016/j.arth.2013.10.016. DOI: https://doi.org/10.1016/j.arth.2013.10.016
Grammatopoulos G, Pandit H, Kambouroglou G, Deakin M, Gundle R, McLardy-Smith P, et al. A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement. Injury 2011; 42(11): 1271-6. doi: 10.1016/j.injury.2011.01.008. DOI: https://doi.org/10.1016/j.injury.2011.01.008
Powell-Bowns M F R, Oag E, Martin D, Clement N D, Scott C E H. Vancouver B and C periprosthetic fractures around the cemented Exeter stem: sex is associated with fracture pattern. Arch Orthop Trauma Surg 2022; 142(11): 3221-8. doi: 10.1007/s00402-021-04113-6. DOI: https://doi.org/10.1007/s00402-021-04113-6
Löwenhielm G, Hansson L I, Kärrholm J. Fracture of the lower extremity after total hip replacement. Arch Orthop Trauma Surg 1989; 108(3): 141-3. doi: 10.1007/BF00934256 DOI: https://doi.org/10.1007/BF00934256
Sah A P, Thornhill T S, LeBoff M S, Glowacki J. Correlation of plain radiographic indices of the hip with quantitative bone mineral density. Osteoporos Int 2007; 18(8): 1119-26. doi: 10.1007/s00198-007-0348-6. DOI: https://doi.org/10.1007/s00198-007-0348-6
Gromov K, Bersang A, Nielsen C S, Kallemose T, Husted H, Troelsen A. Risk factors for post-operative periprosthetic fractures following primary total hip arthroplasty with a proximally coated double-tapered cementless femoral component. Bone Joint J 2017; 99-b(4): 451-7. doi: 10.1302/0301-620x.99b4.bjj-2016-0266.r2. DOI: https://doi.org/10.1302/0301-620X.99B4.BJJ-2016-0266.R2
Stevens J, Clement N, Nasserallah M, Millar M, Joseph S. Femoral cortical thickness influences the pattern of proximal femoral periprosthetic fractures with a cemented stem. Eur J Orthop Surg Traumatol 2018; 28(4): 659-65. doi: 10.1007/s00590-018-2141-y. DOI: https://doi.org/10.1007/s00590-018-2141-y
Fuchtmeier B, Galler M, Muller 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. doi: 10.1016/j.arth.2014.11.006. DOI: https://doi.org/10.1016/j.arth.2014.11.006
Kinov P, Volpin G, Sevi R, Tanchev P P, Antonov B, Hakim G. Surgical treatment of periprosthetic femoral fractures following hip arthroplasty: our institutional experience. Injury 2015; 46(10): 1945-50. doi: 10.1016/j.injury.2015.06.017. DOI: https://doi.org/10.1016/j.injury.2015.06.017
Drew J M, Griffin W L, Odum S M, Van Doren B, Weston B T, Stryker L S. Survivorship after periprosthetic femur fracture: factors affecting outcome. J Arthroplasty 2016; 31(6): 1283-8. doi: 10.1016/j.arth.2015.11.038. DOI: https://doi.org/10.1016/j.arth.2015.11.038
Additional Files
Published
How to Cite
License
Copyright (c) 2023 Ali Sattar, Johan Kärrholm, Michael Möller, Georgios Chatziagorou
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
