Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain.
Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain.
J Arthroplasty. 2021 Sep;36(9):3318-3325. doi: 10.1016/j.arth.2021.05.003. Epub 2021 May 10.
It is recommended revision for periprosthetic hip fractures (PPHF) with a loose stem. However, several authors have argued that under certain conditions, this fracture could be treated using osteosynthesis. The aim is to compare stem revision versus internal fixation in the treatment of PPHF with a loose stem.
All patients with PPHF with a loose stem treated by osteosynthesis and stem revision between January 2009 and January 2019 were included. We assessed hospital stay, American Society of Anesthesiologists, Charlson comorbidity index, surgery time, blood transfusion, complications, reoperation rate, first-year mortality, radiological, and functional results.
A total of 57 patients were included (40 osteosyntheses and 17 stem revision), with an average follow-up time of 3.1 years. Their mean age was 78.47 years (R 45-92). In the osteosynthesis group, fewer patients required blood transfusion (32.5% vs. 70.6%), surgical times were shorter (108 minutes vs. 169 minutes), and the cost was lower, both in terms of total cost (€14,239.07 vs. €21,498.45 and operating room cost (€5014.63 vs. €8203.34). No significant differences were found between the groups in terms of complications, reoperation rate, or functional outcomes.
Compared with stem revision, osteosynthesis requires less surgery time, has a lower need for blood transfusions, and a reduced hospital cost. Stem revision remains the treatment of choice in PPHF with a loose stem, but in V-B2 fractures in elderly patients with low functional demand, high anesthetic risk (American Society of Anesthesiologists ≥3), and many comorbidities (Charlson comorbidity index ≥5) in whom anatomic reconstruction is possible, osteosynthesis can be a viable option.
Historical cohorts. Level III.
对于假体周围髋部骨折（PPHF）伴松动的假体，建议进行翻修。然而，有几位作者认为，在某些情况下，这种骨折可以通过内固定来治疗。本研究旨在比较翻修与内固定治疗伴松动假体的 PPHF 的效果。
纳入了 2009 年 1 月至 2019 年 1 月间采用内固定或翻修术治疗 PPHF 伴松动假体的所有患者。我们评估了住院时间、美国麻醉医师协会（ASA）评分、Charlson 合并症指数、手术时间、输血、并发症、再手术率、1 年死亡率、影像学和功能结果。
共纳入 57 例患者（内固定组 40 例，翻修组 17 例），平均随访时间为 3.1 年。患者平均年龄为 78.47 岁（45-92 岁）。在内固定组中，更少的患者需要输血（32.5%比 70.6%），手术时间更短（108 分钟比 169 分钟），且费用更低，总费用分别为€14,239.07 比€21,498.45 和手术费用€5014.63 比€8203.34。两组在并发症、再手术率或功能结果方面无显著差异。
与翻修相比，内固定术需要的手术时间更短，输血需求更少，且住院费用更低。对于 PPHF 伴松动假体，翻修仍然是首选治疗方法，但对于 V-B2 型骨折、高龄、功能需求低、麻醉风险高（ASA≥3）、合并症多（Charlson 合并症指数≥5）、解剖重建可能的患者，内固定术是一种可行的选择。
回顾性队列研究。III 级。
