Clinical and radiographical outcome after surgical treatment of periprosthetic type B proximal femur fractures: a retros
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ORIGINAL ARTICLE
Clinical and radiographical outcome after surgical treatment of periprosthetic type B proximal femur fractures: a retrospective study G. Agostini1 · I. Angelini1 · C. Citarelli1 · L. Andreani1 · F. Carmassi1 · M. Scaglione1 · R. Capanna1 Received: 30 July 2018 / Accepted: 27 July 2020 © Istituto Ortopedico Rizzoli 2020
Abstract Purpose Periprosthetic fractures after hip prosthesis represent a constantly increasing clinical problem and a challenging complication to treat surgically. Among these, type B proximal femur fractures should be diagnosed correctly to be treated surgically. The aim of this study was to re-evaluate the type of surgical treatment of periprosthetic fractures. Methods We examined the cases treated between January 2012 and February 2018, classifying them according to the U.C.S. AO/OTA. We evaluated the radiographic outcome according to the Beals and Tower criteria. Patients still alive were also re-evaluated according to the H.H.S. and the WOMAC score. Results We treated 48 patients (12 men, 35 women, average age 81 years), divided into 24 type B1, 14 type B2 and 10 type B3 fractures. The overall consolidation rate was 95.4%, while the major complication (implant dislocation, pseudoarthrosis and deep infection) rate was 12.5%. Clinically, it was possible to reassess 34 patients with a mean follow-up of 38.4 months, an average HHS of 75.89 and a mean WOMAC score of 79.93. Conclusions Periprosthetic type B fractures are difficult to manage and require careful preoperative planning and appropriate intraoperative management. However, the overall clinical and radiographic result was satisfactory, although patients should still be aware of the risk of complications associated with this type of fracture. Keywords UCS classification · Osteosynthesis · Harris hip score · Periprothesic hip fractures
Introduction Periprosthetic fractures (PPFs) are defined as fractures around orthopaedics hardware like plates, nails or joint replacements [1]. Periprosthetic fractures around the hip are one of the major causes of failure after a primary hip replacement. According to the Swedish Hip Arthroplasy Register, PPF is the fourth cause of primary hip replacement revision after aseptic loosening, dislocation and infection. Several studies suggest that the rate of PPFs could be between 0.1 and 18% after primary hip replacement and could range from 4 to 11% after primary hip revisions [2]. The 20-year overall probability to have a PPF after primary hip replacement is about 3.5% [3]. Due to the increasing numbers of * G. Agostini [email protected] 1
Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
hip replacement surgeries, hip revision surgery in elderly patients and increasing average life expectations, we can predict a huge increase in PPFs prevalence [4]. The most influencing risk factors are age, female sex, uncemented implants, osteoporosis, longevity of the implant and bone loss [2]. Many classification systems have been developed over the years, and
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