Scalici et al. BMC Musculoskeletal Disorders (2022) 23:200
https://doi.org/10.1186/s12891-022-05159-2
Periprosthetic femoral fractures in Total Hip Arthroplasty (THA): a comparison between osteosynthesis and revision in a retrospective cohort study
Abstract Background: Periprosthetic femoral fractures are challenging complications of hip arthroplasty. They are supposed to be a rare complication, but their incidence is rapidly increasing. Surgical treatment aims to achieve early mobilization and avoid the complications of prolonged bed rest. Aim of this study is to evaluate the clinical outcomes of surgical treatment comparing two surgical approaches: revision arthroplasty (RA) versus open reduction and internal fxation (ORIF).
Methods: Authors retrospectively reviewed a series of 117 patients with total hip arthroplasty treated for periprosthetic femur fractures in the period between January 2013 and March 2018 at a single tertiary referral center. Of these, 70 patients satisfed strict inclusion criteria. Patients were classifed according to the Unifed Classifcation System (UCS) and distributed in two groups according to surgical treatment. Clinical outcomes were assessed using the Oxford Hip recorded preoperatively and post operatively, Barthel Score, CIRS score (Cumulative illness rating scale), type of fracture and post-operative complications with a minimum follow up of 1 year.
Results: Nominal univariate statistical analysis revealed signifcant diferences between the post and pre operative Oxford Hip Score (Δ Oxford) and the surgical treatment (p=0.008) and CIRS score (p=0.048). Moreover, we observed a signifcant relationship between type of treatment and type of fracture (p=0.0001). Multivariate analyses revealed that CIRS score was independently associated with Oxford Score improvement after surgery (p=0.024).
Conclusions: Data from this case series confrmed that surgical treatment was correlated to type of fracture, according to UCS classifcation. Patients treated by RA had a better functional outcome than patients treated with ORIF, but these results are strongly infuenced from the patients’ age, Barthel index and CIRS score. Also, authors found a correlation between functional outcome and comorbidities evaluated by CIRS score. Based on these data we suggest a multimodal approach to these patients, like those used for proximal femoral fractures.
Keywords: Periprosthetic fractures, Hip arthroplasty, Revision arthroplasty, CIRS score
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