Results after surgical treatment of periprosthetic proximal femoral fractures. Osteosynthesis with prosthesis preservation vs. prosthesis change
Background: Periprosthetic fractures (PPF) of the femur close to the hip joint have serious consequences for most geriatric affected patients. In principle, apart from the highly uncommon conservative therapy, there are two therapeutic options. On the one hand, the prosthesis-preserving treatment by...
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German Medical Science GMS Publishing House
2020-09-01
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Series: | GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW |
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Online Access: | http://www.egms.de/static/en/journals/iprs/2020-9/iprs000146.shtml |
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language |
deu |
format |
Article |
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DOAJ |
author |
Zajonz, Dirk Pönick, Cathleen Edel, Melanie Möbius, Robert Pfeifle, Christian Prietzel, Torsten Roth, Andreas Fakler, Johannes K. M. |
spellingShingle |
Zajonz, Dirk Pönick, Cathleen Edel, Melanie Möbius, Robert Pfeifle, Christian Prietzel, Torsten Roth, Andreas Fakler, Johannes K. M. Results after surgical treatment of periprosthetic proximal femoral fractures. Osteosynthesis with prosthesis preservation vs. prosthesis change GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW periprosthetic proximal femoral fracture osteosynthesis prosthesis change |
author_facet |
Zajonz, Dirk Pönick, Cathleen Edel, Melanie Möbius, Robert Pfeifle, Christian Prietzel, Torsten Roth, Andreas Fakler, Johannes K. M. |
author_sort |
Zajonz, Dirk |
title |
Results after surgical treatment of periprosthetic proximal femoral fractures. Osteosynthesis with prosthesis preservation vs. prosthesis change |
title_short |
Results after surgical treatment of periprosthetic proximal femoral fractures. Osteosynthesis with prosthesis preservation vs. prosthesis change |
title_full |
Results after surgical treatment of periprosthetic proximal femoral fractures. Osteosynthesis with prosthesis preservation vs. prosthesis change |
title_fullStr |
Results after surgical treatment of periprosthetic proximal femoral fractures. Osteosynthesis with prosthesis preservation vs. prosthesis change |
title_full_unstemmed |
Results after surgical treatment of periprosthetic proximal femoral fractures. Osteosynthesis with prosthesis preservation vs. prosthesis change |
title_sort |
results after surgical treatment of periprosthetic proximal femoral fractures. osteosynthesis with prosthesis preservation vs. prosthesis change |
publisher |
German Medical Science GMS Publishing House |
series |
GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW |
issn |
2193-8091 |
publishDate |
2020-09-01 |
description |
Background: Periprosthetic fractures (PPF) of the femur close to the hip joint have serious consequences for most geriatric affected patients. In principle, apart from the highly uncommon conservative therapy, there are two therapeutic options. On the one hand, the prosthesis-preserving treatment by means of osteosynthesis using plates and/or cerclages in general is available. On the other hand, a (partial) change of the prosthesis with optionally additive osteosynthesis or a proximal femoral replacement can be performed because of prosthesis loosening or non-reconstructable comminuted fractures as well as most cemented stem variations.The aim of this retrospective study is the analysis of periprosthetic proximal femoral fractures in the presence of a total hip arthroplasty (THA). The outcome of the operated patients is to be investigated depending on the type of care (osteosynthesis with prosthesis preservation vs. prosthesis change).Material and methods: In a retrospective case analysis, 80 patients with THA and PPF were included. They were divided into two groups. Group I represents the osteosynthetic treatment to preserve the implanted THA (n=42). Group II (n=38) includes those patients who were treated by a change of their endoprosthesis with or without additional osteosynthesis. Specifics of all patients, like gender, age at fracture, interval between fracture and implantation, length of in-patient stay, body mass index, osteoporosis, corticomedullary index and complications such as infections, re-fracture, loosening, material failure or other complications, were recorded and compared. Furthermore, the patients were re-examined by a questionnaire and the score according to Merle d’Aubigné and Postel.Results: In group I the mean follow-up time was 48.5±23 months ears) whereas group II amounted 32.5±24.5 months (2.7 years) (p=0.029). Besides, there were significant differences in age (81± 1ears vs. 76±10 years, p=0.047) and length of in-patient stay (14.5±8.6 days vs. 18.0±16.7 days, p=0.014). According to the score of Merle d’Aubigné and Postel, there were significantly better values for the pain in group II with comparable values for mobility and walking ability.Conclusion: The treatment of periprosthetic proximal fractures of the femur is dependent on the classification (Vancouver and Johannsen) and in particular on the prosthetic anchoring as well as the extent of the comminution zone. Older patients and patients with osteoporosis are more frequently treated with an endoprosthesis revision. Patients, who have been treated with an osteosynthesis for preserving their endoprosthesis, showed a shorter length of in-patient stay and fewer complications than people with replacement surgery. In contrast to that, patients with prosthesis revision had better outcomes concerning the score of Merle d’Aubigné and Postel. |
topic |
periprosthetic proximal femoral fracture osteosynthesis prosthesis change |
url |
http://www.egms.de/static/en/journals/iprs/2020-9/iprs000146.shtml |
work_keys_str_mv |
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doaj-65134fc60a604310883124de350cbeea2020-11-25T02:35:49ZdeuGerman Medical Science GMS Publishing HouseGMS Interdisciplinary Plastic and Reconstructive Surgery DGPW2193-80912020-09-019Doc0210.3205/iprs000146Results after surgical treatment of periprosthetic proximal femoral fractures. Osteosynthesis with prosthesis preservation vs. prosthesis changeZajonz, Dirk0Pönick, Cathleen1Edel, Melanie2Möbius, Robert3Pfeifle, Christian4Prietzel, Torsten5Roth, Andreas6Fakler, Johannes K. M.7Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, GermanyDepartment of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, GermanyDepartment of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, GermanyDepartment of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, GermanyDepartment of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, GermanyZESBO – Center for research on musculoskeletal systems, Leipzig, GermanyDepartment of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, GermanyDepartment of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, GermanyBackground: Periprosthetic fractures (PPF) of the femur close to the hip joint have serious consequences for most geriatric affected patients. In principle, apart from the highly uncommon conservative therapy, there are two therapeutic options. On the one hand, the prosthesis-preserving treatment by means of osteosynthesis using plates and/or cerclages in general is available. On the other hand, a (partial) change of the prosthesis with optionally additive osteosynthesis or a proximal femoral replacement can be performed because of prosthesis loosening or non-reconstructable comminuted fractures as well as most cemented stem variations.The aim of this retrospective study is the analysis of periprosthetic proximal femoral fractures in the presence of a total hip arthroplasty (THA). The outcome of the operated patients is to be investigated depending on the type of care (osteosynthesis with prosthesis preservation vs. prosthesis change).Material and methods: In a retrospective case analysis, 80 patients with THA and PPF were included. They were divided into two groups. Group I represents the osteosynthetic treatment to preserve the implanted THA (n=42). Group II (n=38) includes those patients who were treated by a change of their endoprosthesis with or without additional osteosynthesis. Specifics of all patients, like gender, age at fracture, interval between fracture and implantation, length of in-patient stay, body mass index, osteoporosis, corticomedullary index and complications such as infections, re-fracture, loosening, material failure or other complications, were recorded and compared. Furthermore, the patients were re-examined by a questionnaire and the score according to Merle d’Aubigné and Postel.Results: In group I the mean follow-up time was 48.5±23 months ears) whereas group II amounted 32.5±24.5 months (2.7 years) (p=0.029). Besides, there were significant differences in age (81± 1ears vs. 76±10 years, p=0.047) and length of in-patient stay (14.5±8.6 days vs. 18.0±16.7 days, p=0.014). According to the score of Merle d’Aubigné and Postel, there were significantly better values for the pain in group II with comparable values for mobility and walking ability.Conclusion: The treatment of periprosthetic proximal fractures of the femur is dependent on the classification (Vancouver and Johannsen) and in particular on the prosthetic anchoring as well as the extent of the comminution zone. Older patients and patients with osteoporosis are more frequently treated with an endoprosthesis revision. Patients, who have been treated with an osteosynthesis for preserving their endoprosthesis, showed a shorter length of in-patient stay and fewer complications than people with replacement surgery. In contrast to that, patients with prosthesis revision had better outcomes concerning the score of Merle d’Aubigné and Postel.http://www.egms.de/static/en/journals/iprs/2020-9/iprs000146.shtmlperiprosthetic proximal femoral fractureosteosynthesisprosthesis change |