Division of Orthopaedic Surgery, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada.
J Arthroplasty. 2018 Mar;33(3):878-881. doi: 10.1016/j.arth.2017.10.045. Epub 2017 Nov 9.
Periprosthetic femur fractures around total hip (THA) and total knee (TKA) arthroplasties are difficult complications to manage. With native hip fractures, delay to fixation has been correlated with an increase in postoperative mortality. The effect of time to definitive fixation of periprosthetic femur fractures around THA and TKA is not well established. The aim of our study is to evaluate the effect of time to definitive fixation on postoperative length of stay and mortality for patients with periprosthetic femur fractures around THA and TKA.
A review of 2537 arthroplasty patient charts yielded 235 patients who were diagnosed with a periprosthetic femur fracture at our institution from 2005 to 2014. Time to surgical management, length of stay, demographics, referral status, fracture classification, and fixation modality along with mortality was recorded for all patients.
One hundred eighty patients met study inclusion (111 THAs, 69 TKAs). Average age was 79.2 years and 72.2% were female. The average time from admission to definitive fixation was 96.5 hours with 31.1% of patients having surgery within 48 hours after presenting to hospital. Postoperative length of stay and mortality were not affected by time to definitive fixation greater than 48 hours for either of the periprosthetic TKA or THA patient cohorts. Postoperative mortality within 1 year was 5.5% for all patients (6.3% THA, 4.3% TKA).
The timing of fixation of periprosthetic femur fractures does not appear to affect postoperative length of stay or mortality within 1 year.
全髋关节置换术（THA）和全膝关节置换术（TKA）周围的股骨假体周围骨折是难以处理的并发症。对于原发性髋部骨折，固定时间的延迟与术后死亡率的增加相关。THA 和 TKA 周围股骨假体周围骨折的确定性固定时间对术后住院时间和死亡率的影响尚未明确。我们研究的目的是评估 THA 和 TKA 周围股骨假体周围骨折的确定性固定时间对术后住院时间和死亡率的影响。
对 2537 例关节置换患者的病历进行回顾，发现 2005 年至 2014 年期间我院有 235 例患者被诊断为假体周围股骨骨折。记录所有患者的手术管理时间、住院时间、人口统计学特征、转诊状态、骨折分类、固定方式以及死亡率。
180 例患者符合研究纳入标准（111 例 THA，69 例 TKA）。平均年龄为 79.2 岁，72.2%为女性。从入院到确定性固定的平均时间为 96.5 小时，31.1%的患者在入院后 48 小时内进行手术。对于 TKA 或 THA 患者组，超过 48 小时进行确定性固定不会影响术后住院时间或死亡率。所有患者术后 1 年内的死亡率为 5.5%（6.3%的 THA，4.3%的 TKA）。
股骨假体周围骨折的固定时间似乎不会影响术后 1 年内的住院时间或死亡率。
