Introduction: Implant fixation assessment following Vancouver B1 periprosthetic hip fracture is a major decision factor for internal fixation and/or implant revision. The main aim of the present study was to assess the correlation between radiographic Remaining Attachment Index (RAI) and risk of implant loosening at last follow-up following internal fixation of Vancouver B1 periprosthetic hip fracture.
Material And Method: A multicentre retrospective study included 50 patients with Vancouver B1 periprosthetic hip fracture with uncemented femoral stem between 2013 and 2019. Preoperative radiographs were analysed independently by 2 senior orthopedic surgeons, distinguishing 2 groups: RAI>2/3 versus<2/3. Postoperative and last follow-up radiographs were then screened for signs of complete femoral component loosening.
Results: Median age was 89 years (range: 36-99 years). Two RAI>2/3 patients showed implant loosening (8%) versus 9 RAI<2/3 patients (36%), disclosing a significant correlation between early loosening and RAI<2/3 (p=0.005). Interobserver agreement for both radiographic RAI and radiographic loosening assessment at last follow-up was 98% with kappa correlation coefficient 0.96 [range: 0.88-1].
Conclusion: Remaining Attachment Index<2/3 in Vancouver B1 periprosthetic hip fracture was a risk factor for early implant loosening after isolated internal fixation. In these often frail elderly patients, first-line implant exchange is to be considered in the light of the risk/benefit ratio. The present results confirm the need for rigorous preoperative radiographic work-up of the remaining attachment area in Vancouver B1 fracture.
Level Of Evidence: IV.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.otsr.2020.06.016 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Sandwiched Strut Allografts with Stem Retention to Treat Fragile Periprosthetic Femoral Fractures: A Case Report.
Medicina (Kaunas)
January 2025
Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmundae-ro, Dong-gu, Gwangju 61453, Republic of Korea.
Managing periprosthetic femoral fractures is challenging, particularly in osteoporotic patients with fragile bones. Revision with a long stem is commonly considered but may fail to provide adequate fixation and stability in fragile bones. A novel approach using sandwiched strut allografts and controlled bone crushing with robust cable fixation can offer mechanical support and provide secondary stability to the loosened femoral stem and can be considered a treatment option for low-demand patients.
View Article and Find Full Text PDFMultiplanar Semicircular New-Generation Implant System Developed for Proximal Femur Periprosthetic Fractures: A Biomechanical Study.
Medicina (Kaunas)
January 2025
Department of Orthopedics and Traumatology, Karabük University, Karabük 78050, Turkey.
The study aimed to evaluate a newly designed semicircular implant for the fixation of Vancouver Type B1 periprosthetic femoral fractures (PFFs) in total hip arthroplasty (THA) patients. To determine its strength and clinical applicability, the new implant was compared biomechanically with conventional fixation methods, such as lateral locking plate fixation and a plate combined with cerclage wires. : Fifteen synthetic femur models were used in this biomechanical study.
View Article and Find Full Text PDFFar Cortical Locking Versus Standard Constructs for Locked Plate Fixation in the Treatment of Acute, Displaced Fractures of the Distal Femur: A Multicenter Randomized Trial.
J Bone Joint Surg Am
October 2024
Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Background: Fixation of distal femoral fractures remains a challenge, and nonunions are common with standard constructs. Far cortical locking (FCL) constructs have been purported to lead to improved fracture-healing as compared with that achieved with traditional locking bridge plates. We sought to test this hypothesis in a comparative effectiveness clinical trial.
View Article and Find Full Text PDFCost Effectiveness of Fixation Versus Total Hip Arthroplasty in Vancouver B2 Periprosthetic Femur Fractures: A Predictive Markov Analysis.
J Am Acad Orthop Surg
January 2025
From the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Scott, Blackburn, Prasad, Lim, Lavoie-Gagne, Melnic, and Bedair), and the Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA (Scott, Blackburn, Prasad, Lim, Melnic, and Bedair).
Background: Although Vancouver B2 periprosthetic fractures (PPFs) have been historically managed with revision total hip arthroplasty (rTHA), open reduction and internal fixation (ORIF) has been proposed as an alternative option for reasons including lower cost and surgical time. The purpose of this study was to, therefore, create a Markov model to assess the cost effectiveness of ORIF versus rTHA for Vancouver B2 periprosthetic femur fractures and evaluate various inflection points for varying costs and outcome measures.
Methods: A Markov model was built using discrete and mutually exclusive health states of the hypothetical patient with Vancouver B2 PPF.
Periprosthetic femur fractures around the hip are one of the most common aseptic complications following total hip arthroplasty. Understanding the risk factors of periprosthetic femur fracture can aid surgeons in the prevention of these injuries. The Vancouver classification provides a reproducible description of the factors that should be considered in the treatment of patients with periprosthetic femur fractures: fracture site, implant stability, and bone stock.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!