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Influence of treatment modality on morbidity and mortality in periprosthetic femoral fracture. A comparative study of 71 fractures treated by internal fixation or femoral implant revision - 24/04/18

Doi : 10.1016/j.otsr.2017.12.018 
S. Cohen, X. Flecher , S. Parratte, M. Ollivier, J.-N. Argenson
 Institut du Mouvement et de l’Appareil Locomoteur, UMR CNRS 7287/AMU, Centre Hospitalo-Universitaire Sud, hôpital Sainte-Marguerite, boulevard de Sainte-Marguerite, 13009 Marseille, France 

Corresponding author. Service de chirurgie orthopédique, hôpital Sainte-Marguerite, boulevard de Sainte-Marguerite, 13009 Marseille, France.Service de chirurgie orthopédique, hôpital Sainte-Marguerite, boulevard de Sainte-Marguerite, 13009 Marseille, France.

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Abstract

Introduction

The incidence of periprosthetic femoral fracture is constantly increasing, with high associated morbidity and mortality. Surgical treatment is guided by the Vancouver classification, but the influence of type of treatment on morbidity and mortality has been little analyzed. The theoretical advantage of implant revision over internal fixation is that it should allow earlier weight-bearing, although the impact of this on morbidity and mortality and autonomy has not been demonstrated. We conducted a case-control study, to assess the influence of type of treatment (implant revision or internal fixation) (1) on mobility and autonomy and (2) on morbidity and mortality.

Hypothesis

The study hypothesis was that clinical results and morbidity and mortality do not differ between these two types of treatment.

Methods

A retrospective study included 70 patients with a total of 71 femoral periprosthetic fractures treated between 2007 and 2014. Two treatment groups, comparable for mean age, gender and ASA and Parker scores, were studied. Mean age was 78±13.5years (range, 23−95years). Thirty-six fractures (50.7%) were treated by implant revision via a posterolateral approach, using a revision stem with (n=11) or without cement (n=25) (REVISION group); immediate postoperative weight-bearing was authorized. Thirty-five fractures (49.3%) were treated by open reduction and internal fixation, using a locking plate (ORIF group); weight-bearing was authorized only in the third month. Mean follow-up was 43±27months (range, 0.75−107months).

Results

Autonomy on Parker score was reduced by 2 points at 1year's follow-up. Mean preoperative scores were 7.32±1.79 (range, 3–9) and 7.43±1.79 (range, 4–9) in the REVISION and ORIF group, respectively, (p=0.8), falling to 5.06±2.6 (range, 0–9) and 4.5±2.01 (range, 0–9) respectively at follow-up (p=0.349). Sixteen patients in the REVISION group versus 13 in the ORIF group had made adaptations in their home or changed place of residence (p=0.2). At last follow-up, 18 patients (28.6%) had died: 12 (37.5%) in the ORIF and 6 (19.3%) in the REVISION group (p<0.05). Survival with death as endpoint at a mean 3.5years was 88±11% in the REVISION group versus 51±11% in the ORIF group (p=0.02). Three implant replacements were performed in each group (p=0.83). Twelve medical or surgical complications occurred in the ORIF group (37.5%) and 11 in the REVISION group (34%) (p=0.9).

Conclusion

Implant revision for periprosthetic femoral fracture showed significantly lower overall mortality than internal fixation, without difference in terms of treatment failure or complications requiring revision surgery.

Level of evidence

Level III, case-control study.

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Keywords : Periprosthetic femoral fracture, Total hip arthroplasty, Implant revision, Internal fixation, Morbidity, Mortality


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© 2018  Publié par Elsevier Masson SAS.
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Vol 104 - N° 3

P. 363-367 - mai 2018 Retour au numéro
Article précédent Article précédent
  • Computer-assisted surgery in acetabular fractures: Virtual reduction of acetabular fracture using the first patient-specific biomechanical model simulator
  • M. Boudissa, H. Oliveri, M. Chabanas, J. Tonetti
| Article suivant Article suivant
  • Comparison of dual mobility total hip arthroplasty and bipolar arthroplasty for femoral neck fractures: A retrospective case-control study of 199 hips
  • B. Boukebous, P. Boutroux, R. Zahi, C. Azmy, P. Guillon

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