Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
Department of Anesthesia, Johns Hopkins University, Baltimore, MD.
J Arthroplasty. 2021 Jul;36(7):2597-2602. doi: 10.1016/j.arth.2021.02.048. Epub 2021 Feb 23.
Periprosthetic femur fracture is one of the most common indications for reoperation after total hip arthroplasty. Our objectives were to evaluate the incidence of reoperation after the surgical treatment of periprosthetic femur fractures and to compare the mechanisms of failure between fractures around a stable femoral component and those with an unstable femoral component.
We identified a consecutive series of 196 surgically treated periprosthetic fractures after total hip arthroplasty between 2008 and 2017. Mean age was 72 years (range, 29-96 years), and 108 (55%) were women. The femoral component was unstable in 127 cases (65%) and stable in the remaining 69 cases (35%). Mean follow-up was 2 years.
The 2-year cumulative probability of any reoperation was 19%. The most common indication for reoperation among the cases with a stable femoral component was nonunion, and the most common indication for reoperation among the cases with an unstable femoral component was infection. Fractures that originated at the distal aspect of the femoral component were associated with a high risk of nonunion (6 of 28 cases, P < .01) and reoperation (9 of 28 cases, P = .03).
Surgeons should take measures to mitigate the failure modes that are distinct based on fracture type. The high infection rate after surgical management of B fracture suggests that additional antiseptic precautions may be warranted. For B fractures, particularly those originating near the distal aspect of the femoral component, augmenting fixation with orthogonal plating, spanning the entire femur, or revising the stem in cases of poor proximal bone should be considered.
髋关节置换术后股骨假体周围骨折是再次手术的最常见原因之一。我们的目的是评估手术治疗股骨假体周围骨折后的再手术发生率，并比较稳定股骨假体周围骨折与不稳定股骨假体周围骨折的失败机制。
我们确定了 2008 年至 2017 年间连续 196 例髋关节置换术后股骨假体周围骨折的病例。平均年龄为 72 岁（范围 29-96 岁），108 例（55%）为女性。127 例（65%）股骨假体不稳定，其余 69 例（35%）稳定。平均随访 2 年。
2 年任何再手术的累积概率为 19%。股骨假体稳定的病例中最常见的再手术指征是非愈合，而股骨假体不稳定的病例中最常见的再手术指征是感染。股骨假体远端起源的骨折与非愈合（28 例中的 6 例，P<.01）和再手术（28 例中的 9 例，P=.03）的高风险相关。
外科医生应采取措施减轻基于骨折类型的不同失败模式。手术后 B 型骨折的高感染率表明，可能需要额外的抗菌预防措施。对于 B 型骨折，特别是股骨假体远端附近起源的骨折，应考虑使用正交钢板固定、跨越整个股骨或在近端骨质量不佳的情况下更换假体以增强固定。
