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Postoperative periprosthetic fractures in patients with an Exeter stem due to a femoral neck fracture: cumulative incidence and surgical outcome

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Abstract

Purpose

The purpose of this study is to report on the cumulative incidence and the outcome of surgically-treated postoperative PPFs in patients with femoral neck fractures treated with a THA or HA using an Exeter stem.

Methods

A consecutive series of patients operated during 1998–2010 due to a non-pathological femoral neck fracture using an Exeter stem were included in this cohort study. Patients were followed until 2012, or death, in order to obtain information about reoperations due to postoperative PPFs, and subsequent re-operations after surgery due to PPFs. In addition to local audit data the Swedish National Board of Health and Welfare’s registry was used to identify patients who had been re-operated upon elsewhere in Sweden.

Results

A total of 2,757 patients (median age 82 years, 2,019 females) were identified and included in the study. Of these patients, 63 (2.3 %) sustained a postoperative PPF that was treated surgically. The majority of the Vancouver B1 (n = 21/23) and C (n = 14/14) fractures were treated using open reduction and internal fixation (ORIF), whereas most of the B2 (n = 16/25) fractures and the only B3 fracture were treated with stem revision. Three (4.8 %) patients were subsequently re-operated upon due to fracture-related complications, all B2 fractures, and were treated with ORIF (n = 2) or stem revision (n = 1).

Conclusion

The cumulative incidence of surgically treated PPFs was considerable among patients with Exeter stems operated due to a femoral neck fracture. The re-operation rate due to fracture-related complications was highest among patients with B2 fractures.

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References

  1. Berry DJ (1999) Epidemiology: hip and knee. Orthop Clin N Am 30:183–190

    Article  CAS  Google Scholar 

  2. SHAR (2012) Annual report 2012. In: Register SHA (ed) http://www.shpr.se/sv/Publications/DocumentsReports.aspx. Accessed 17 October 2014

  3. Lindahl H, Garellick G, Regner H, Herberts P, Malchau H (2006) Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am 88:1215–1222. doi:10.2106/JBJS.E.00457

    Article  PubMed  Google Scholar 

  4. Samuelsson B, Hedstrom MI, Ponzer S, Soderqvist A, Samnegard E, Thorngren KG, Cederholm T, Saaf M, Dalen N (2009) Gender differences and cognitive aspects on functional outcome after hip fracture–a 2 years’ follow-up of 2,134 patients. Age Ageing 38:686–692. doi:10.1093/ageing/afp169

    Article  PubMed  Google Scholar 

  5. Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304

    CAS  PubMed  Google Scholar 

  6. Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg Br 64:17–19

    CAS  PubMed  Google Scholar 

  7. Lindahl H, Malchau H, Herberts P, Garellick G (2005) Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplast 20:857–865. doi:10.1016/j.arth.2005.02.001

    Article  Google Scholar 

  8. Phillips JR, Moran CG, Manktelow AR (2013) Periprosthetic fractures around hip hemiarthroplasty performed for hip fracture. Injury 44:757–762. doi:10.1016/j.injury.2012.09.015

    Article  CAS  PubMed  Google Scholar 

  9. McGraw IW, Spence SC, Baird EJ, Eckhardt SM, Ayana GE (2013) Incidence of periprosthetic fractures after hip hemiarthroplasty: are uncemented prostheses unsafe? Injury 44:1945–1948. doi:10.1016/j.injury.2013.07.023

    Article  PubMed  Google Scholar 

  10. Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Tornkvist H, Ponzer S, Tidermark J (2011) Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am 93:445–450. doi:10.2106/JBJS.J.00474

    Article  PubMed  Google Scholar 

  11. Johansson T (2014) Internal fixation compared with total hip replacement for displaced femoral neck fractures: a minimum fifteen-year follow-up study of a previously reported randomized trial. J Bone Joint Surg Am 96:e46. doi:10.2106/JBJS.K.00244

    Article  PubMed  Google Scholar 

  12. Berry DJ (2002) Management of periprosthetic fractures: the hip. J Arthroplast 17:11–13

    Article  Google Scholar 

  13. Tsiridis E, Haddad FS, Gie GA (2003) The management of periprosthetic femoral fractures around hip replacements. Injury 34:95–105

    Article  PubMed  Google Scholar 

  14. Tsiridis E, Pavlou G, Venkatesh R, Bobak P, Gie G (2009) Periprosthetic femoral fractures around hip arthroplasty: current concepts in their management. Hip Int J Clin Exp Res Hip Pathol Ther 19:75–86

    Google Scholar 

  15. Holzapfel BM, Prodinger PM, Hoberg M, Meffert R, Rudert M, Gradinger R (2010) Periprosthetic fractures after total hip arthroplasty: classification, diagnosis and therapy strategies. Orthopade 39:519–535. doi:10.1007/s00132-010-1612-6

    Article  CAS  PubMed  Google Scholar 

  16. Sen R, Prasad P, Kumar S, Nagi O (2007) Periprosthetic femoral fractures around well fixed implants: a simple method of fixation using LC-DCP with trochanteric purchase. Acta Orthop Belg 73:200–206

    PubMed  Google Scholar 

  17. Bryant GK, Morshed S, Agel J, Henley MB, Barei DP, Taitsman LA, Nork SE (2009) Isolated locked compression plating for Vancouver Type B1 periprosthetic femoral fractures. Injury 40:1180–1186. doi:10.1016/j.injury.2009.02.017

    Article  PubMed  Google Scholar 

  18. Munro JT, Garbuz DS, Masri BA, Duncan CP (2014) Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures. Clin Orthop Relat Res 472:590–598. doi:10.1007/s11999-013-3087-3

    Article  PubMed Central  PubMed  Google Scholar 

  19. Masri BA, Meek RM, Duncan CP (2004) Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 420:80–95

  20. Buttaro MA, Farfalli G, Paredes Nunez M, Comba F, Piccaluga F (2007) Locking compression plate fixation of Vancouver type-B1 periprosthetic femoral fractures. J Bone Joint Surg Am 89:1964–1969. doi:10.2106/JBJS.F.01224

    Article  CAS  PubMed  Google Scholar 

  21. Wahnert D, Schroder R, Schulze M, Westerhoff P, Raschke M, Stange R (2014) Biomechanical comparison of two angular stable plate constructions for periprosthetic femur fracture fixation. Int Orthop 38:47–53. doi:10.1007/s00264-013-2113-0

    Article  PubMed Central  PubMed  Google Scholar 

  22. Lindahl H, Malchau H, Oden A, Garellick G (2006) Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br 88:26–30. doi:10.1302/0301-620X.88B1.17029

    Article  CAS  PubMed  Google Scholar 

  23. Pavlou G, Panteliadis P, Macdonald D, Timperley JA, Gie G, Bancroft G, Tsiridis E (2011) A review of 202 periprosthetic fractures–stem revision and allograft improves outcome for type B fractures. Hip Int J Clin Exp Res Hip Pathol Ther 21:21–29

    Google Scholar 

  24. Sheth NP, Brown NM, Moric M, Berger RA, Della Valle CJ (2013) Operative treatment of early peri-prosthetic femur fractures following primary total hip arthroplasty. J Arthroplast 28:286–291. doi:10.1016/j.arth.2012.06.003

    Article  Google Scholar 

  25. Schwarzkopf R, Oni JK, Marwin SE (2013) Total hip arthroplasty periprosthetic femoral fractures: a review of classification and current treatment. Bull Hosp Jt Dis 71:68–78

    Google Scholar 

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Contribution of authors

CI: design of the study, radiological classification of fractures, data analysis, manuscript preparation. AE: design of the study, radiological classification of fractures, data analysis, manuscript preparation.

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No competing interests declared.

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Authors and Affiliations

  1. Department of Clinical Science and Education, Section of Orthopaedics, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden

    Christian Inngul & Anders Enocson

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  1. Christian Inngul
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  2. Anders Enocson
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Correspondence to Christian Inngul.

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Inngul, C., Enocson, A. Postoperative periprosthetic fractures in patients with an Exeter stem due to a femoral neck fracture: cumulative incidence and surgical outcome. International Orthopaedics (SICOT) 39, 1683–1688 (2015). https://doi.org/10.1007/s00264-014-2570-0

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  • DOI: https://doi.org/10.1007/s00264-014-2570-0

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