Morgan Samuel, Bourget-Murray Jonathan, Garceau Simon, Grammatopoulos George
Department of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada.
Ann Jt. 2023 Jul 10;8:30. doi: 10.21037/aoj-23-16. eCollection 2023.
The aging population and the increasing number of patients with primary total hip arthroplasties (THA) has equated to an increased incidence of periprosthetic fractures (PPF) of the hip. These injuries are a significant source of patient morbidity and mortality, placing a financial burden on healthcare systems worldwide. As the volume of PPF is expected to along with the growing volume of primary and revision THA, it is important to understand the outcomes and factors associated with treatment success. The choice of procedure is in large part guided by the help of the Vancouver Classification system, which is a valid and reproducible system that classifies fractures based on several factors including site of fracture, implant stability and bone stock. PPFs account for approximately 18% of revision THA (rTHA) procedures. rTHA for PPFs is commonly indicated in Vancouver B2 and B3 fractures, to bypass a lack of metaphyseal support with diaphyseal fixation. Such revisions are technically challenging and typically require urgent treatment, with inherent difficulties in patient optimization, leading to a notable rate of post-operative complications, re-revision and mortality. This article reviews epidemiology, health economics and risk factors for PPFs. It additionally reviews outcomes associated with rTHA for PPFs including peri-operative complications, indications for re-operation, rates of re-operation and rates of mortality. Finally, it aims to identify evidence-based factors that have been associated with successful management including modifiable patient-related factors, uncemented cemented stems, stem design (porous coated stems fluted tapered stems), modularity, dislocation and its impact on outcomes following rTHA and strategies for managing bone loss.
人口老龄化以及初次全髋关节置换术（THA）患者数量的增加，导致髋关节假体周围骨折（PPF）的发生率上升。这些损伤是患者发病和死亡的重要原因，给全球医疗系统带来了经济负担。由于预计PPF的数量将随着初次和翻修THA数量的增加而增加，了解与治疗成功相关的结果和因素非常重要。手术方式的选择在很大程度上受温哥华分类系统的指导，该系统是一个有效且可重复的系统，根据骨折部位、植入物稳定性和骨量等多种因素对骨折进行分类。PPF约占翻修THA（rTHA）手术的18%。PPF的rTHA通常适用于温哥华B2和B3型骨折，以通过骨干固定绕过干骺端支撑不足的问题。此类翻修手术技术上具有挑战性，通常需要紧急治疗，在患者优化方面存在固有困难，导致术后并发症、再次翻修和死亡率较高。本文综述了PPF的流行病学、卫生经济学和危险因素。此外，还综述了PPF的rTHA相关结果，包括围手术期并发症、再次手术指征、再次手术率和死亡率。最后，旨在确定与成功治疗相关的循证因素，包括可改变的患者相关因素、非骨水泥型与骨水泥型假体柄、假体柄设计（多孔涂层假体柄与带槽锥形假体柄）、模块化、脱位及其对rTHA后结果的影响以及处理骨丢失的策略。
