Elsevier

The Journal of Arthroplasty

Volume 29, Issue 2, February 2014, Pages 422-427
The Journal of Arthroplasty

Proximal Femoral Replacement in the Management of Acute Periprosthetic Fractures of the Hip: A Competing Risks Survival Analysis

https://doi.org/10.1016/j.arth.2013.06.009Get rights and content

Abstract

To examine the mortality and implant survivorship of proximal femoral replacement (PFR), revision total hip arthroplasty (REV) and open reduction internal fixation (ORIF) in the treatment of acute periprosthetic fractures of the proximal femur, we retrospectively reviewed 97 consecutive acute periprosthetic proximal femoral fractures from 2000 to 2010. Three groups were defined: PFR (n = 21), REV (n = 19), and ORIF (n = 57). Outcome measures were all-cause mortality, implant failure, and reoperation. Competing Risks survival analysis of overall mortality during the mean 35-month follow-up showed no statistical difference between the three groups (P = 0.65; 12 and 60 month mortality for PFR: 37%, 45%; REV: 16%, 46%; ORIF: 14%, 100%). Implant survival was worse for the PFR group (P = 0.03, 12 and 60-month implant failure rate for PFR: 5%, 39%; REV: 7%, 7%; ORIF 2%, 2%). We conclude that PFR as compared with REV or ORIF may have worse medium-term implant survival, primarily due to instability and dislocation.

Section snippets

Study Design and Statistics

After obtaining approval from our institutional review board, we performed a retrospective analysis of 97 consecutive periprosthetic hip fractures treated at our center from 2000 to 2010. Inclusion criteria for the study included Vancouver grade A, B, or C periprosthetic fracture of the proximal femur around a primary or revision total or hemiarthroplasty femoral implant [14]. In addition, the index operation for periprosthetic fracture took place at our institution without exception. Exclusion

Demographics and Follow-Up

For the entire series of 97 patients, mean patient age at fracture was 72. There was no significant difference between the three groups with regard to age, gender, BMI, or medical comorbidities with the exception of chronic pulmonary disease, which was more prevalent in the PFR group (Table 1). The distribution of our patient population according to the Vancouver classification of periprosthetic fractures [14] is outlined in Table 2. The PFR group had a significantly greater proportion of

Discussion

In treating difficult periprosthetic fractures around proximal femoral implants, we found that PFR as compared with REV or ORIF has no significant difference in short and medium-term patient mortality but does have worse medium-term implant survival related to late instability and infection. Incidence of summary non-death complications was statistically similar between the three groups, but complications which lead to implant revision such as dislocation and infection may be higher in the PFR

Acknowledgments

We would like to acknowledge Dan Winger, MS, Li Wang, and Clare Bunker, MPH, PhD, for their contributions to the statistical work. The project described was supported by the National Institutes of Health through Grant Numbers UL1 RR024153 and UL1TR000005.

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    Portions of the statistical work were made possible by Grant No. 2UL1 RR024153-06 from the National Center to Advance Translational Research (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.

    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.06.009.

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