Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Injury. 2021 Nov;52(11):3461-3470. doi: 10.1016/j.injury.2021.02.039. Epub 2021 Feb 17.
Type I, flat-wedge and type II, dual-wedge stems are currently two common stem types used in primary, uncemented hip arthroplasty. The prevalence of periprosthetic femur fracture is higher in type I stems, possibly because of the different shapes and areas of bone contact. We aimed to compare the fracture pattern, stem stability during the fracture and type of subsequent procedures in periprosthetic femur fractures between type I and II stems.
This was a retrospective, cross-sectional study conducted in a single tertiary referral hospital of Taipei, Taiwan. We included primary hip arthroplasty procedures using type I or type II stems complicated with postoperative periprosthetic femur fractures. We recorded the age, sex, ASA grade, index procedure, institution of where the index procedure was performed, trauma mechanism, time from index procedure to fracture, procedure for periprosthetic fracture and radiographic parameters including Dorr type, Vancouver classification, stem stability, fracture pattern, type and brand of the stems for analysis.
We included 132 patients who had undergone surgery for periprosthetic femur fracture for type I (N = 46) or type II (N = 86) stems. The mean age was 74.5 years and 52.3% of the patients were female. Type I stems were associated with a higher proportion of a complex fracture pattern (52.2% vs. 8.2%), femoral stem loosening (78.2% vs. 60.4%) and a higher rate of revision stem procedures (69.6% vs. 50.0%) compared with type II stems. Using multivariate analysis, type I stem was the only factor for a complex fracture pattern in the overall population (aOR: 23.60, 95% CI: 6.54-85.16), hemiarthroplasty (aOR: 160.50, 95% CI: 9.77-2635.95) and total hip arthroplasty (aOR: 14.17, 95% CI: 2.92-68.79) subgroups.
We observed a difference in fracture patterns between type I and type II stems. Type I stems appear to be an independent risk factor for a complex fracture pattern in patients who had undergone primary hip arthroplasty.
在初次非骨水泥髋关节置换术中，目前使用的股骨柄类型主要有Ⅰ型（平楔形）和Ⅱ型（双楔形）。Ⅰ型股骨柄假体周围股骨骨折的发生率较高，这可能与柄的形状和骨接触面积不同有关。我们旨在比较Ⅰ型和Ⅱ型股骨柄假体周围股骨骨折的骨折类型、骨折时柄的稳定性以及后续手术类型。
这是一项在台湾台北一家三级转诊医院进行的回顾性、横断面研究。我们纳入了初次髋关节置换术中使用Ⅰ型或Ⅱ型股骨柄并随后发生术后假体周围股骨骨折的患者。我们记录了患者的年龄、性别、ASA 分级、指数手术、指数手术的机构、创伤机制、从指数手术到骨折的时间、假体周围骨折的处理方法以及包括 Dorr 分型、温哥华分型、股骨柄稳定性、骨折类型、股骨柄类型和品牌等放射学参数。
我们纳入了 132 例因Ⅰ型（N=46）或Ⅱ型（N=86）股骨柄发生假体周围股骨骨折而接受手术的患者。患者的平均年龄为 74.5 岁，52.3%为女性。与Ⅱ型股骨柄相比，Ⅰ型股骨柄更易发生复杂骨折类型（52.2%比 8.2%）、股骨柄松动（78.2%比 60.4%）以及更高的翻修股骨柄率（69.6%比 50.0%）。多因素分析显示，在总体人群中，Ⅰ型股骨柄是复杂骨折类型的唯一因素（优势比：23.60，95%置信区间：6.54-85.16）、半髋关节置换术（优势比：160.50，95%置信区间：9.77-2635.95）和全髋关节置换术（优势比：14.17，95%置信区间：2.92-68.79）亚组。
我们观察到Ⅰ型和Ⅱ型股骨柄之间的骨折类型存在差异。在初次髋关节置换术后的患者中，Ⅰ型股骨柄似乎是复杂骨折类型的独立危险因素。
