Brodén Cyrus, Mukka Sebastian, Muren Olle, Eisler Thomas, Boden Henrik, Stark André, Sköldenberg Olof
Department of Orthopedics at Danderyd Hospital and Department of Clinical Sciences at Danderyd Hospital (KIDS) , Karolinska Institutet , Stockholm.
Acta Orthop. 2015 Apr;86(2):169-74. doi: 10.3109/17453674.2014.971388. Epub 2014 Oct 3.
Postoperative periprosthetic femoral fracture (PPF) after hip arthroplasty is associated with considerable morbidity and mortality. We assessed the incidence and characteristics of periprosthetic fractures in a consecutive cohort of elderly patients treated with a cemented, collarless, polished and tapered femoral stem (CPT).
In this single-center prospective cohort study, we included 1,403 hips in 1,357 patients (mean age 82 (range 52-102) years, 72% women) with primary osteoarthritis (OA) or a femoral neck fracture (FNF) as indication for surgery (367 hips and 1,036 hips, respectively). 64% of patients were ASA class 3 or 4. Hip-related complications and need for repeat surgery were assessed at a mean follow-up time of 4 (1-7) years. A Cox regression analysis was used to evaluate risk factors associated with PPF.
47 hips (3.3%) sustained a periprosthetic fracture at median 7 (2-79) months postoperatively; 41 were comminute Vancouver B2 or complex C-type fractures. The fracture rate was 3.8% for FNF patients and 2.2% for OA patients (hazard ratio (HR) = 4; 95% CI: 1.3-12). Patients > 80 years of age also had a higher risk of fracture (HR = 2; 95% CI: 1.1-4.5).
We found a high incidence of early PPF associated with the CPT stem in this old and frail patient group. A possible explanation may be that the polished tapered stem acts as a wedge, splitting the femur after a direct hip contusion. Our results should be confirmed in larger, registry-based studies, but we advise caution when using this stem for this particular patient group.
髋关节置换术后假体周围股骨骨折（PPF）与较高的发病率和死亡率相关。我们评估了一组连续接受骨水泥型、无领、抛光和锥形股骨柄（CPT）治疗的老年患者中假体周围骨折的发生率和特征。
在这项单中心前瞻性队列研究中，我们纳入了1357例患者的1403髋（平均年龄82岁（范围52 - 102岁），72%为女性），这些患者因原发性骨关节炎（OA）或股骨颈骨折（FNF）而接受手术（分别为367髋和1036髋）。64%的患者为美国麻醉医师协会（ASA）3或4级。在平均4年（1 - 7年）的随访时间里评估髋关节相关并发症及再次手术的需求。采用Cox回归分析评估与PPF相关的危险因素。
47髋（3.3%）在术后中位时间7个月（2 - 79个月）发生假体周围骨折；41例为温哥华B2型粉碎性骨折或复杂C型骨折。FNF患者的骨折率为3.8%，OA患者为2.2%（风险比（HR） = 4；95%置信区间：1.3 - 12）。年龄大于80岁的患者骨折风险也更高（HR = 2；95%置信区间：1.1 - 4.5）。
在这个老年体弱患者群体中，我们发现与CPT股骨柄相关的早期PPF发生率较高。一种可能的解释是，抛光的锥形柄起到了楔形作用，在髋关节直接挫伤后导致股骨劈裂。我们的结果应在更大规模的基于注册登记的研究中得到证实，但对于这个特定患者群体使用该股骨柄时我们建议谨慎。
