Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Department of Orthopedic Surgery, RWJ Barnabas Health Jersey Medical Center, Jersey City, New Jersey.
Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
J Arthroplasty. 2022 Sep;37(9):1827-1831. doi: 10.1016/j.arth.2022.04.020. Epub 2022 Apr 22.
Early periprosthetic fractures (PPFx) following primary total hip arthroplasty (THA) create significant morbidity. Established risk factors for early PPFx include age, gender, body mass index, surgical approach, and implant fixation. We investigated the role of femoral fixation on early PPFx (<90 days postoperatively) in a high-risk cohort undergoing direct anterior approach (DAA) THA.
The final cohort comprised 344 consecutive patients (390 hips) with risk factors for PPFx (age >68 years and body mass index <25 kg/m) who underwent primary DAA THA between May 4, 2009 and December 31, 2019 and had 90-day follow-up. Noncemented fixation was used in 229-hips, while cemented fixation was used in 161 hips. The primary outcome was early PPFx. Fisher's exact test was used for categorical variables, while t-tests were used to compare continuous variables.
We observed 8 early PPFx (2.1%), all fractures occurring in the noncemented group. Baseline demographics were similar but not equal, with the cemented group being older (78.0 versus 76.3 years; P = .004) with a greater proportion of females (91.9% versus 69.4%; P < .001). The rate of early PPFx was significantly higher with noncemented fixation compared to cemented fixation (3.5% versus 0.0%; P = .023). A post hoc power analysis confirmed sufficient power (1-β = 0.81).
Although baseline risk factors for early PPFx are not easily modifiable, surgical factors can be modified. Cemented fixation has the potential to markedly reduce the risk of early PPFx in high-risk patients undergoing DAA THA.
初次全髋关节置换术后（THA）早期发生的假体周围骨折（PPFx）会导致严重的发病率。早期 PPFx 的既定危险因素包括年龄、性别、体重指数、手术入路和植入物固定。我们研究了在接受直接前侧入路（DAA）THA 的高危患者中，股骨固定对早期 PPFx（<90 天术后）的作用。
最终队列包括 344 例（390 髋）有 PPFx 风险因素的连续患者（年龄>68 岁和体重指数<25kg/m），他们于 2009 年 5 月 4 日至 2019 年 12 月 31 日期间接受了初次 DAA THA，并进行了 90 天随访。229 髋采用非骨水泥固定，161 髋采用骨水泥固定。主要结果是早期 PPFx。使用 Fisher 确切检验进行分类变量，使用 t 检验进行连续变量比较。
我们观察到 8 例早期 PPFx（2.1%），均发生在非骨水泥组。基线人口统计学数据相似但不相等，骨水泥组年龄较大（78.0 岁比 76.3 岁；P =.004），女性比例较高（91.9%比 69.4%；P <.001）。与骨水泥固定相比，非骨水泥固定的早期 PPFx 发生率显著更高（3.5%比 0.0%；P =.023）。事后功效分析证实具有足够的功效（1-β=0.81）。
尽管早期 PPFx 的基线危险因素不易改变，但手术因素可以改变。在接受 DAA THA 的高危患者中，骨水泥固定有可能显著降低早期 PPFx 的风险。
