Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA; Anderson Orthopaedic Research Institute, Alexandria, VA.
Anderson Orthopaedic Research Institute, Alexandria, VA.
J Arthroplasty. 2021 Jul;36(7S):S363-S366. doi: 10.1016/j.arth.2021.02.012. Epub 2021 Feb 23.
Periprosthetic femur fracture (PFF) remains a common reason for failure after total hip arthroplasty (THA). For over 10 years, our institution has performed both anterior approach (AA) and posterolateral (PL) approaches for primary THA with multiple stem designs. The aim of this study is to determine the 90-day relative risk of PFF with regard to approach and stem design.
A retrospective review of our institutional database was performed on all patients undergoing primary THA from 2007 to 2018 using AA or PL approaches. Five surgeons performing 6309 THAs (AA = 4510; PL = 1799) using single-wedge taper (n = 2417) or fit-and-fill (n = 3892) stems were included. PFF occurring within 90 days of the index procedure were analyzed. Differences in PFF rates, fracture location, stem type, and treatment method were assessed. Comparisons were made using a Cox regression analysis.
The 90-day revision rate for fracture was 0.3%. Clinically significant fractures requiring cerclage cabling, stem change, revision, or open reduction internal fixation occurred in 0.9% of patients (intraoperative = 37, 0.6%; postoperative = 17, 0.3%). Cox regression found PFF risk was significant for female patients (P = .008), patients older than age 65 (P < .01), single-wedge taper stems (P = .05), and for cases with collarless stems (P = .04). Among PFF cases that required surgical intervention, risk factors were female sex, age older than 65, and body mass index under 25 (P < .05). Collarless stems were 2.6 times more likely to result in PFF than collared stems (P = .04). Single-wedge taper stems were 2.3 times more likely to result in PFF than fit-and-fill stems (P = .05). Approach was not found to be an independent risk factor for PFF (P = .85).
Our single-center experience demonstrates the risk of periprosthetic fracture within 90 days of surgery is significantly lower with collared stems and fit-and-fill stem designs. Female sex, age over 65, and body mass index below 25 nearly double the PFF risk. Surgical approach did not influence fracture rates.
股骨假体周围骨折（PFF）仍然是全髋关节置换术（THA）后失败的常见原因。在过去的 10 年中，我们机构对使用多种柄设计的初次 THA 同时采用前入路（AA）和后外侧（PL）入路。本研究旨在确定与入路和柄设计相关的 PFF 在 90 天内的相对风险。
对 2007 年至 2018 年期间采用 AA 或 PL 入路行初次 THA 的患者进行回顾性研究，纳入 5 名外科医生施行的 6309 例 THA（AA=4510 例，PL=1799 例），使用单楔形锥形（n=2417）或适配填充（n=3892）柄。分析术后 90 天内出现的 PFF。评估 PFF 发生率、骨折部位、柄类型和治疗方法的差异。采用 Cox 回归分析进行比较。
骨折的 90 天翻修率为 0.3%。需要环扎电缆、更换柄、翻修或切开复位内固定的临床显著骨折发生率为 0.9%（术中=37 例，0.6%；术后=17 例，0.3%）。Cox 回归分析发现，女性（P=0.008）、年龄大于 65 岁（P<0.01）、单楔形锥形柄（P=0.05）和无领柄（P=0.04）的 PFF 风险显著。需要手术干预的 PFF 病例的危险因素为女性、年龄大于 65 岁、体重指数低于 25（P<0.05）。无领柄发生 PFF 的可能性是有领柄的 2.6 倍（P=0.04）。单楔形锥形柄发生 PFF 的可能性是适配填充柄的 2.3 倍（P=0.05）。手术入路不是 PFF 的独立危险因素（P=0.85）。
本单中心经验表明，使用带领柄和适配填充柄设计的假体在术后 90 天内发生假体周围骨折的风险显著降低。女性、年龄大于 65 岁和体重指数低于 25 会使 PFF 风险增加近一倍。手术入路并不影响骨折发生率。
