Apprich Sebastian R, Nia Arastoo, Schreiner Markus M, Jesch Maximilian, Böhler Christoph, Windhager Reinhard
Department of Orthopaedic and Trauma Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, 1090, Vienna, Austria.
Wien Klin Wochenschr. 2021 Jun;133(11-12):550-559. doi: 10.1007/s00508-021-01838-7. Epub 2021 Apr 13.
Periprosthetic fractures (PPF) of the femur remain challenging, especially in patients with previous multiple revisions. Modular megaprostheses (mMPs) are rarely used in this indication; however, in some cases mMPs seem to be the last chance for limb salvage. We aimed to evaluate the clinical outcome of PPFs of the femur treated by modular mMPs at our institution.
In this study 33 patients (27 female; mean age 79 years) with a PPF after total hip or total knee arthroplasty (no tumor indications) were treated using modular proximal (mPFR; n = 12), distal (mDFR; n = 14) or total (mTFR; n = 7) femur replacement. A retrospective evaluation regarding mortality and revision rates was performed. Failures with need for revision were classified.
At a mean follow up of 60 months (range 0-178 months), the total mortality rate as well as total revision rate were both found to be 39%. At 1 year follow-up the mortality rate was highest within the mDFR group, and less revisions were necessary in the mPFR group, however both findings were not significantly. Those patients, who had revision surgery before PPF, were found to have higher revision rate after implantation of mMP. In the mPFR group, dislocation was the most frequent failure, within the mDFR and the mTFR group infection. In one case amputation of the lower limb was necessary.
mMPs represent a valuable option in PPFs of the femur. Infection and dislocation remain the most frequent complications. Prospective clinical studies are required to further define the outcome of mMPs in PPFs of the femur.
股骨假体周围骨折（PPF）仍然具有挑战性，尤其是在既往有多次翻修手术的患者中。模块化大型假体（mMPs）很少用于这种情况；然而，在某些情况下，mMPs似乎是挽救肢体的最后机会。我们旨在评估在我们机构使用模块化mMPs治疗股骨PPF的临床结果。
在本研究中，33例（27例女性；平均年龄79岁）全髋关节或全膝关节置换术后发生PPF（无肿瘤指征）的患者接受了模块化近端（mPFR；n = 12）、远端（mDFR；n = 14）或全股骨（mTFR；n = 7）置换治疗。对死亡率和翻修率进行了回顾性评估。对需要翻修的失败情况进行了分类。
平均随访60个月（范围0 - 178个月），总死亡率和总翻修率均为39%。在1年随访时，mDFR组的死亡率最高，mPFR组需要的翻修较少，但这两个结果均无显著差异。在PPF之前接受过翻修手术的患者，在植入mMP后翻修率较高。在mPFR组中，脱位是最常见的失败原因，在mDFR组和mTFR组中感染是最常见的失败原因。有1例患者需要截肢。
mMPs是股骨PPF的一种有价值的选择。感染和脱位仍然是最常见的并发症。需要进行前瞻性临床研究以进一步明确mMPs在股骨PPF中的治疗结果。
