Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
OrthoVirginia, Fair Oaks, Virginia.
J Arthroplasty. 2024 Oct;39(10):2607-2614.e1. doi: 10.1016/j.arth.2024.05.018. Epub 2024 May 10.
Interprosthetic femur fractures (IPFFs) are a rare, but devastating complication following total joint arthroplasty. There is limited evidence to help guide their management. The purpose of this study was to describe the features, treatment, and outcomes of surgically managed IPFFs.
We retrospectively identified 75 patients who had 76 IPFFs. The mean age at the time of IPFF was 75 years (range, 29 to 94), and 78% were women. The mean body mass index was 30 (range, 19 to 51), and the mean follow-up was 3 years (range, 0 to 14). There were 16 Vancouver B1 fractures, 28 Vancouver B2 fractures, 2 Vancouver B3 fractures, and 30 Vancouver C fractures. All B1 fractures underwent open reduction internal fixation (ORIF). All Vancouver B2 and B3 fractures underwent revision arthroplasty, including 1 proximal femur replacement and 1 total femur replacement. Vancouver C fractures were treated with ORIF (n = 20), distal femoral replacement (n = 9), and in 1 case, total femur replacement (n = 1). Kaplan-Meier survivorship was used to calculate 2-year survival free from all-cause reoperation and periprosthetic joint infection (PJI).
The 2-year survivorship-free rate from reoperation was 71%. There were 18 reoperations following initial surgical management of the IPFF, including 9 for infection, 3 for refracture, 3 for nonunion, 2 for hardware failure, and 1 for instability. An initial IPFF involving a stemmed femoral total knee arthroplasty component was associated with increased risk for reoperation (P = .007) and PJI (P = .044). There was no difference in survivorship free of reoperation between IPFFs managed with ORIF or revision arthroplasty (P = .72).
An IPFF is a devastating complication following total joint arthroplasty with high reoperation rates, most commonly secondary to PJI. Those IPFFs that occurred between 2 stemmed components were at the highest risk for reoperation.
假体间股骨骨折（IPFF）是全关节置换术后一种罕见但破坏性的并发症。目前，指导其治疗的证据有限。本研究旨在描述手术治疗 IPFF 的特点、治疗方法和结果。
我们回顾性确定了 75 例 76 例 IPFF 患者。IPFF 时的平均年龄为 75 岁（范围 29 至 94 岁），78%为女性。平均体重指数为 30（范围 19 至 51），平均随访时间为 3 年（范围 0 至 14 年）。16 例为温哥华 B1 型骨折，28 例为温哥华 B2 型骨折，2 例为温哥华 B3 型骨折，30 例为温哥华 C 型骨折。所有 B1 型骨折均行切开复位内固定（ORIF）。所有温哥华 B2 和 B3 型骨折均行翻修关节置换术，其中 1 例行近端股骨置换术，1 例行全股骨置换术。温哥华 C 型骨折采用 ORIF（n=20）、股骨远端置换术（n=9）和 1 例全股骨置换术治疗。采用 Kaplan-Meier 生存法计算 2 年无全因再次手术和假体周围关节感染（PJI）的生存率。
2 年无再手术生存率为 71%。初次 IPFF 手术治疗后有 18 例再手术，其中 9 例为感染，3 例为再骨折，3 例为骨不连，2 例为内固定失败，1 例为不稳定。累及带柄股骨全膝关节置换组件的初始 IPFF 与再次手术（P=0.007）和 PJI（P=0.044）的风险增加相关。ORIF 或翻修关节置换术治疗的 IPFF 之间再手术生存率无差异（P=0.72）。
IPFF 是全关节置换术后一种破坏性并发症，再手术率高，最常见的是继发于 PJI。那些发生在 2 个带柄组件之间的 IPFF 再次手术的风险最高。
