Clinical Management and Outcome of Periprosthetic Fracture

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 31 May 2024 | Viewed by 4451

Special Issue Editor


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Guest Editor
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
Interests: hip and knee primary arthroplasty; hip and knee revision arthroplasty; hip arthroscopy; hip osteotomies; periprosthetic joint infection; fast-track; artificial intelligence; regenerative medicine

Special Issue Information

Dear Colleagues,

The incidence of periprosthetic fractures of the lower extremity has increased over the last few years. In the literature, the rate of periprosthetic fractures is around 1% in total hip arthroplasty and from 1% up to 5% in total knee arthroplasty. The aging of population and the increasing number of primary and revision hip and knee replacements are both critical factors resulting in the increased incidence of periprosthetic fractures. Several studies have been published in the past, investigating the risk factors, postoperative morbidity and mortality risk, and management of patients with periprosthetic fractures of the hip and knee.

This issue will present a selected group of articles representing an update on the clinical management and outcome of periprosthetic fracture.

Prof. Dr. Mattia Loppini
Guest Editor

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Keywords

  • periprosthetic fracture
  • trauma
  • hip replacement
  • knee replacement 
  • primary
  • revision
  • diagnosis
  • outcome
  • operative management 
  • non-operative management

Published Papers (4 papers)

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13 pages, 12394 KiB  
Article
Clinical and Radiographic Outcomes of Hip Revision Surgery and Cerclage Wires Fixation for Vancouver B2 and B3 Fractures: A Retrospective Cohort Study
by Vincenzo Di Matteo, Francesco La Camera, Carla Carfì, Emanuela Morenghi, Guido Grappiolo and Mattia Loppini
J. Clin. Med. 2024, 13(3), 892; https://doi.org/10.3390/jcm13030892 - 3 Feb 2024
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Abstract
Background: The number of patients presenting with periprosthetic hip fractures has increased in recent decades. Methods: Patients who underwent hip revision arthroplasty procedures for Vancouver type B2 and B3 fractures between 2010 and 2021 were included. The primary intended outcome of this study [...] Read more.
Background: The number of patients presenting with periprosthetic hip fractures has increased in recent decades. Methods: Patients who underwent hip revision arthroplasty procedures for Vancouver type B2 and B3 fractures between 2010 and 2021 were included. The primary intended outcome of this study was to determine the reintervention-free survival rate. The secondary intended outcome was to determine clinical and radiographic assessment outcomes at the time of follow-up, and the correlation between time to surgery and postoperative Harris hip score (HHS). Results: A total of 49 patients with mean age of 71.2 ± 2.3 (37–88) years old were included. Overall, the Kaplan-Meier method estimated a survival rate of 95.8% (CI 84.2% to 98.9%) at one year, 91.1% (CI 77.9% to 96.6%) at two years, and 88.5% (CI 74.4% to 95.1%) at three, and up to 10, years. The mean limb length discrepancy (LLD) improved from −13.3 ± 10.5 (range −39 to +10) mm at the preoperative stage to −1.16 ± 6.7 (range −17 to +15) mm, p < 0.001 postoperative. The mean HHS improved from 31.1 ± 7.7 (range 10 to 43) preoperative to 85.5 ± 14.8 (range 60 to 100), p < 0.001 postoperative. Postoperative HHS was not affected by preoperative time to surgery. Conclusions: Revision arthroplasty is an effective treatment for Vancouver type B2 and B3 fractures. Full article
(This article belongs to the Special Issue Clinical Management and Outcome of Periprosthetic Fracture)
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8 pages, 407 KiB  
Article
Periprosthetic Fractures around Total Hip Replacement—Is There a Rush to Fix?
by Timothy Boddice, Peter Harrison, Christopher Anthony and Aaron B. Y. Ng
J. Clin. Med. 2023, 12(10), 3512; https://doi.org/10.3390/jcm12103512 - 17 May 2023
Cited by 1 | Viewed by 1104
Abstract
Background: Periprosthetic fractures now account for 14.1% of all hip revisions. Surgery is often highly specialised and can involve the revision of implants, fixation of fractures, or a combination of both. Delays to surgery are frequent as specialist equipment and surgeons are often [...] Read more.
Background: Periprosthetic fractures now account for 14.1% of all hip revisions. Surgery is often highly specialised and can involve the revision of implants, fixation of fractures, or a combination of both. Delays to surgery are frequent as specialist equipment and surgeons are often required. UK guidelines are currently moving in favour of early surgery in a similar way to the neck of femur fractures, despite a lack of evidential consensus. Methods: A retrospective review of all patients who underwent surgery for periprosthetic fractures around a total hip replacement (THR) at a single unit between 2012 and 2019 was performed. Risk factors for complications, length of stay (LOS), and time to surgery data were collected and analysed using regression analysis. Results: A total of 88 patients met the inclusion criteria: 63 (72%) were treated with open reduction internal fixation (ORIF) and 25 (28%) underwent revision THR. Baseline characteristics were similar in both the ORIF and revision groups. Revision surgery was more likely to be delayed than ORIF owing to the need for specialist equipment and personnel (median 143 h vs. 120 h, p = 0.04). Median LOS was 17 days if operated within 72 h and 27 days if delayed beyond this (p < 0.0001), but there was no increase in 90-day mortality (p = 0.66), HDU admission (p = 0.33), or perioperative complications (p = 0.27) with delay beyond 72 h. Conclusion: Periprosthetic fractures are complex and require a highly specialised approach. Delaying surgery does not result in increased mortality or complications but does increase length of stay. Further multicentre research into this area is required. Full article
(This article belongs to the Special Issue Clinical Management and Outcome of Periprosthetic Fracture)
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10 pages, 3500 KiB  
Article
Inter-Observer and Intra-Observer Reliability Assessment of the Established Classification Systems for Periprosthetic Shoulder Fractures
by Mats Wiethölter, Doruk Akgün, Fabian Plachel, Marvin Minkus, Daniel Karczewski, Karl Braun, Kathi Thiele, Luis Becker, Ulrich Stöckle and Philipp Moroder
J. Clin. Med. 2023, 12(9), 3168; https://doi.org/10.3390/jcm12093168 - 28 Apr 2023
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Abstract
This study evaluated the reliability and comprehensiveness of the Unified classification system (UCPF), Wright & Cofield, Worland and Kirchhoff classifications and related treatment recommendations for periprosthetic shoulder fractures (PPSFx). Two shoulder arthroplasty specialists (experts) and two orthopaedic residents (non-experts) assessed 20 humeral-sided and [...] Read more.
This study evaluated the reliability and comprehensiveness of the Unified classification system (UCPF), Wright & Cofield, Worland and Kirchhoff classifications and related treatment recommendations for periprosthetic shoulder fractures (PPSFx). Two shoulder arthroplasty specialists (experts) and two orthopaedic residents (non-experts) assessed 20 humeral-sided and five scapula-sided cases of PPSFx. We used the unweighted Cohen’s Kappa (κ) for measuring the intra-observer reliability and Krippendorff’s alpha (α) for measuring the inter-observer reliability. The inter-rater reliabilities for the Wright & Cofield and Worland classifications were substantial for all groups. The expert and non-expert groups for UCPF also showed substantial inter-rater agreement. The all-rater group for the UCPF and the expert and non-expert group for the Kirchhoff classification revealed moderate inter-rater reliability. For the Kirchhoff classification, only fair inter-rater reliability was found for the non-expert group. Almost perfect intra-rater reliability was measured for all groups of the Wright & Cofield classification and the all-rater and expert groups of the UCPF. All groups of the Kirchhoff and Worland classifications and the group of non-experts for the UCPF had substantial intra-rater reliabilities. Regarding treatment recommendations, substantial inter-rater and moderate intra-rater reliabilities were found. Simple classification systems for PPSFx (Wright & Cofield, Worland) show the highest inter- and intra-observer reliability but lack comprehensiveness as they fail to describe scapula-sided fractures. The complex Kirchhoff classification shows limited reliability. The UCPF seems to offer an acceptable combination of comprehensiveness and reliability. Full article
(This article belongs to the Special Issue Clinical Management and Outcome of Periprosthetic Fracture)
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10 pages, 16043 KiB  
Case Report
The Treatment of Periprosthetic Fracture Revision of the Humerus with “Bamboo Support” Structural Allograft Technique—Atrophic Non-Union of a Post-Operative Periprosthetic Fracture after Reverse Total Shoulder Arthroplasty: A Case Report
by Hsien-Hao Chang, Joon-Ryul Lim, Tae-Hwan Yoon, Yong-Min Chun and Hyoung-Sik Kim
J. Clin. Med. 2024, 13(3), 825; https://doi.org/10.3390/jcm13030825 - 31 Jan 2024
Viewed by 697
Abstract
Periprosthetic fractures are a serious complication of joint replacement surgery. With the growing prevalence of reverse total shoulder arthroplasty (RTSA), the incidence of relatively uncommon periprosthetic humeral fractures has increased. Here, we present the unique case of a 74-year-old woman who developed atrophic [...] Read more.
Periprosthetic fractures are a serious complication of joint replacement surgery. With the growing prevalence of reverse total shoulder arthroplasty (RTSA), the incidence of relatively uncommon periprosthetic humeral fractures has increased. Here, we present the unique case of a 74-year-old woman who developed atrophic non-union after plate osteosynthesis for a periprosthetic fracture associated with RTSA. Fixation failure was evident 3 months after the surgical intervention; the patient underwent a 3-month course of arm sling immobilization. However, bone resorption continued, and varus angulation of the fracture developed. In this case, surgical strategy involved the use of long proximal humerus internal locked system plate (DePuy Synthes, Paoli, PA, USA), augmented with autologous iliac bone graft and allogenic humerus structural bone graft with the “bamboo support technique”, fixed with Cable System (DePuy Synthes, Paoli, PA, USA). No reports have addressed the management of failed periprosthetic fractures using allogeneic humeral strut bone grafts. This report aims to fill the gap by presenting a novel surgical technique for the management of periprosthetic fractures associated with RTSA in case of treatment failure. Full article
(This article belongs to the Special Issue Clinical Management and Outcome of Periprosthetic Fracture)
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