OrthoCarolina Hip and Knee Center, Charlotte, NC.
American Academy of Orthopaedic Surgeons, IL.
J Arthroplasty. 2019 Jul;34(7S):S352-S354. doi: 10.1016/j.arth.2019.02.004. Epub 2019 Feb 10.
Perioperative periprosthetic femur fractures (PPFx) after total hip arthroplasty (THA) remain a leading cause of early stem failure and revision and are associated with high rates of morbidity and mortality. American Joint Replacement Registry (AJRR) data have been analyzed to determine the relationship of femoral stem fixation to PPFx revision.
All early (≤3 months from index arthroplasty) linked primary and revision hip arthroplasties reported to the AJRR between 2012 and 2017 were analyzed. We evaluated patient demographics, arthroplasty type (hemiarthroplasty vs THA), and stem fixation.
A total of 10,277 linked revisions were reported to the AJRR during 2012-2017. Early PPFx requiring revision occurred in 628 patients (6.1%) due to osteoarthritis (82.4%), femoral neck fracture (12.1%), and other causes (15.6%). Five hundred twenty-nine patients (84%) were treated with THA and 99 patients with hemiarthroplasty (16%). Females (70%) have a higher prevalence of revisions. Fifty-eight percent of patients were ≥70 years of age, and 20% were ≥80 years of age. Patients with cementless stems were 2.6 times (account 94.9% of the fractures, 95% confidence interval 0.59-11.1) more likely to undergo early revision for PPFx than those with cemented fixation, although not statistically significant with its sample size.
Mirroring other studies and national registries, there was an association between cementless fixation and PPFx in AJRR. Nevertheless, AJRR data demonstrate a trend of increasing utilization of cementless femoral fixation for THA and hemiarthroplasty, with cementless fixation accounting for 93% of THA stems with early periprosthetic fracture. Additional analysis is needed to better understand this phenomenon, especially in the elderly.
全髋关节置换术后围手术期股骨假体周围骨折（PPFx）仍然是早期假体失败和翻修的主要原因，并且与高发病率和死亡率相关。已经分析了美国关节置换登记处（AJRR）的数据，以确定股骨假体固定与 PPFx 翻修的关系。
分析了 2012 年至 2017 年期间向 AJRR 报告的所有早期（距指数关节置换术≤3 个月）关联的原发性和翻修髋关节置换术。我们评估了患者人口统计学特征、关节置换类型（半髋关节置换术与全髋关节置换术）和假体固定情况。
2012-2017 年期间，AJRR 共报告了 10277 例关联翻修。由于骨关节炎（82.4%）、股骨颈骨折（12.1%）和其他原因（15.6%），需要翻修的早期 PPFx 发生在 628 例患者（6.1%）。529 例患者（84%）接受了全髋关节置换术，99 例患者接受了半髋关节置换术（16%）。女性（70%）翻修率更高。58%的患者年龄≥70 岁，20%的患者年龄≥80 岁。与使用水泥固定的患者相比，使用非水泥固定假体的患者发生早期 PPFx 翻修的可能性高 2.6 倍（占骨折的 94.9%，95%置信区间 0.59-11.1），但由于样本量较小，其差异无统计学意义。
与其他研究和国家登记处一样，AJRR 中存在非水泥固定与 PPFx 之间的关联。然而，AJRR 数据显示，非水泥固定在全髋关节置换术和半髋关节置换术中的应用呈增加趋势，非水泥固定占早期假体周围骨折的全髋关节置换术假体的 93%。需要进一步分析以更好地了解这种现象，尤其是在老年人中。
