Outcomes following non-operatively managed periprosthetic fractures surrounding uncemented femoral stems

Published:November 03, 2021DOI:https://doi.org/10.1016/j.jcot.2021.101688

      Abstract

      Background

      The primary aim of this study was to explore the outcomes of Vancouver B periprosthetic hip fractures that were managed non-operatively with a particular focus on 1-year mortality. Understanding this mortality data will allow surgeons to better understand the risk associated with non-operative management. The secondary aim was to evaluate our case series and current literature with regards to identifying suitable patients for non-operative treatment.

      Methods

      Our electronic fracture database was interrogated for all Vancouver B periprosthetic fractures treated at our institution between April 2009 to April 2019; 18 patients were identified. All available data was then collected from radiographic, electronic and paper notes. A comprehensive literature search of PUBMED and EMBASE databases was then conducted with all relevant literature reviewed.

      Results

      1-year mortality of these patients was noted at 22.2%; highlighting the severity of these injuries. No patients required conversion to surgical management, sustained a dislocation or went into non-union. With regards to literature no case series focussing on non-operative management outcomes were reported. There was a marked paucity of literature relating to conservative management of these injuries.

      Conclusion

      To our knowledge this is the first published case series focussing solely on nonoperatively managed Vancouver B periprosthetic hip fractures. This paper provides evidence from the first reported case series with which surgeons can counsel patients on the significant mortality risk associated with these fractures. Non-operative management of periprosthetic hip fractures is possible after careful analysis of the fracture configuration, implant and patient characteristics. Whilst we have outlined several findings from our first reported case series, further research is required from a larger prospective case series in order to make evidence based recommendations.

      Keywords

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      References

        • National Joint Registry 15th Annual Report
        HQIP.
        2018 (2018 [cited 2019 Aug 8]. Available from:)
        • Pivec R.
        • Issa K.
        • Kapadia B.H.
        • et al.
        Incidence and future projections of periprosthetic femoral fracture following primary total hip arthroplasty: an analysis of international registry data.
        J Long Term Eff Med Implants. 2015; 25: 269-275
        • Della Rocca G.J.
        • Leung K.S.
        • Pape H.-C.
        Periprosthetic fractures: epidemiology and future projections.
        J Orthop Trauma. 2011; 25: S66-S70
        • Wilson D.
        • Masri B.A.
        • Duncan C.P.
        Periprosthetic fractures: an operative algorithm.
        Orthopedics. 2001; 24: 869-870
        • Haddad F.S.
        Periprosthetic fractures: more challenges ahead.
        Bone Joint Lett J. 2020; 102-B: 547-549
        • Finlayson G.
        • Tucker A.
        • Black N.D.
        • McDonald S.
        • Molloy M.
        • Wilson D.
        Outcomes and predictors of mortality following periprosthethic proximal femoral fractures.
        Injury. 2019; 50: 438-443
        • Kristensen P.K.
        • Perez-Vicente R.
        • Leckie G.
        • Johnsen S.P.
        • Merlo J.
        Disentangling the contribution of hospitals and municipalities for understanding patient level differences in one-year mortality risk after hip-fracture: a cross-classified multilevel analysis in Sweden.
        PLoS One. 2020; 15e0234041
        • Phillips J.R.A.
        • Moran C.G.
        • Manktelow A.R.J.
        Periprosthetic fractures around hip hemiarthroplasty performed for hip fracture.
        Injury. 2013; 44: 757-762
        • Spina M.
        • Scalvi A.
        • Vacchiano A.
        • Sandri A.
        • Balsano M.
        Incomplete, Stable-like, Peri-Prosthetic Vancouver B Fracture Around an Ha-Coated Stem. Is There a Case for Strategic Thoughtful Neglect?.
        Trauma Case Rep, 2019 (Nov 27 [cited 2020 Nov 11];24. Available from:)
        • Zheng H.
        • Gu H.
        • Shao H.
        • et al.
        Treatment and outcomes of Vancouver type B periprosthetic femoral fractures.
        Bone Joint Lett J. 2020; 102-B: 293-300
        • Shields E.
        • Behrend C.
        • Bair J.
        • Cram P.
        • Kates S.
        Mortality and financial burden of periprosthetic fractures of the femur.
        Geriatr Orthop Surg Rehabil. 2014; 5: 147-153
      1. The importance of no evidence.
        Nat Human Behav. 2019; 3 (197): 197
        • Gibbs V.N.
        • McCulloch R.A.
        • Dhiman P.
        • et al.
        Modifiable risk factors for mortality in revision total hip arthroplasty for periprosthetic fracture.
        Bone Joint Lett J. 2020; 102-B: 580-585
        • Füchtmeier B.
        • Galler M.
        • Müller F.
        Mid-term results of 121 periprosthetic femoral fractures: increased failure and mortality within but not after one postoperative year.
        J Arthroplasty. 2015; 30: 669-674
        • Tay E.
        Hip fractures in the elderly: operative versus nonoperative management.
        Singap Med J. 2016; 57: 178-181
        • Folbert E.C.
        • Hegeman J.H.
        • Vermeer M.
        • et al.
        Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment.
        Osteoporos Int. 2017; 28: 269-277
        • Ries C.
        • Boese C.K.
        • Dietrich F.
        • Miehlke W.
        • Heisel C.
        Femoral stem subsidence in cementless total hip arthroplasty: a retrospective single-centre study.
        Int Orthop. 2019; 43: 307-314
        • Metcalfe D.
        • Zogg C.K.
        • Judge A.
        • et al.
        Pay for performance and hip fracture outcomes.
        Bone Joint Lett J. 2019; 101-B: 1015-1023