This article is more than 5 years old. Information may no longer be current.
Routine monitoring of THA patients for femur fractures recommended
More patients with postoperative femur fractures had Charnley and Exeter prostheses.
Click Here to Manage Email Alerts
Periprosthetic femoral fracture remains a devastating complication following total hip arthroplasty. New Swedish research advises routine evaluation of all total hip patients and links fracture risk with implant type.
Using the Swedish National Hip Arthroplasty Register, investigators prospectively studied 230 patients who sustained periprosthetic fractures after total hip replacement (THR) and 91 patients who had fractures following revision procedures.
They discovered that more than half of the primary and revision patients had loose stems at the time of fracture, and that 80% were Vancouver type B fractures. They also discovered that significantly more fracture patients had Charnley [DePuy Orthopaedics] and Exeter [Stryker] implants.
Higher reoperative rate for B1s
The mean 5-year follow-up revealed a 22% overall reoperation rate and showed a higher rate in Vancouver type B1 fractures. Moreover, investigators found that more than a third of surgeons’ grading of Vancouver type B1 fractures disagreed with a radiologist’s assessment.
“A recommendation is to follow all THR patients with regular radiographic monitoring and to intervene before the fracture,” the investigators wrote in their abstract. “Implant-related factors have to be considered when choosing implants for routine use. Difficulty in evaluating the X-rays concerning the stability of the prostheses might lead to suboptimal treatment.
“We recommend exploration of the implant for all patients with Vancouver type B fracture if there is any doubt about the fixation status,” they added.
|
Hans Lindahl, MD, PhD, and his colleagues studied fracture patients entered into the national register between 1999 and 2000. The investigators studied the medical records of the cohort and also took postoperative radiographs of available patients. Of the study group, 217 patients also responded to a postop questionnaire and the investigators assessed Harris hip scores, patient satisfaction and the EuroQol (EQ-5D) scores.
“Sixty-six percent of the primary cases had a loose stem at the time of fracture,” Lindahl said during his presentation at the 8th European Federation of National Associations of Orthopaedics and Traumatology Congress.
Loose components
The investigators also found that 51% of revised patients also had loose components. “Approximately 80% of the fractures were Vancouver type B,” he said.
While the Charnley, Exeter and Lubinus [Waldemar Link] are the most commonly used prostheses in Sweden, Lindahl said that significantly fewer fracture patients had Lubinus components. “Compared with the register, the Charnley and Exeter prostheses were significantly overrepresented among these fracture cases,” he said.
There were no significant differences between the groups regarding age, gender or time between the index procedure and fracture.
He noted that unlike Vancouver B2 and B3 fractures, B1 breaks should only be treated with open reduction and internal fixation. A comparison of surgeon and radiologist assessments revealed that more than 34% of surgeons’ grading for Vancouver B1 fractures did not agree with a radiologist’s classification. The misdiagnosis by surgeons could lead to suboptimal treatment of these fractures, Lindahl said. The research also showed low mean Harris hip scores for the group and lower EQ-5D scores compared to an age-matched cohort of THR patients.
For more information:Reference:
- Hans Lindahl, MD, PhD, can be reached at Sahlgrenska University Hospital, Göteborg, University, SE-413 45 Göteborg, Sweden; +46-31-82-55-99; hans.lindahl@vgregion.se. He has no financial conflicts of interest to disclose.
- Lindahl H, Malchau H, Garellick G, et al. A prospective study on 321 periprosthetic femur fractures reported to the Swedish National Total Hip Arthroplasty Register. #F543. Presented at the 8th European Federation of National Associations of Orthopaedics and Traumatology Congress. May 11-15, 2007. Florence.