From the Harcourt House Sheffield, UK (Mr. Uzoigwe); Hull Royal Infirmary, Hull, UK (Mr. Watts, Mr. Briggs, and Mr. Symes).
J Am Acad Orthop Surg Glob Res Rev. 2024 Aug 6;8(8). doi: 10.5435/JAAOSGlobal-D-23-00135. eCollection 2024 Aug 1.
The proliferation of hip arthroplasty has seen concomitant increases in periprosthetic femoral fractures (PFFs). The most common pattern involves fracture at the level of a loose prosthesis (B2). B2 PFFs have a unique mechanopathogenesis linked to the tendency of polished taper-slip cemented stems to subside in the cement. Such stems carry a much higher PFF risk than other cemented designs. Mega-data, consistent across national registries, suggest that increasing application of the taper-slip principle has resulted in the emergence of highly polished, very low friction cemented prostheses. These have the propensity to migrate within the cement, increasing B2 PFF risk. This would explain the strong association between cobalt-chromium stems and PFF. Is PFF the mode of failure of polished taper-slip stems rather than aseptic loosening? Established wisdom teaches that B2 PFFs should be managed with revision surgery. There is a large body of new evidence that, in certain instances, fixation results in outcomes at least equivalent to revision arthroplasty, with shorter surgical time, decreased transfusion requirements, and lower dislocation risk. This is so in B2 PFFs around cemented polished taper-slip stems with an intact bone-cement interface. We outline advances in understanding of B2 PFF with special reference to mechanopathogenesis and indications for fixation.
髋关节置换术的广泛应用导致了股骨假体周围骨折（PFF）的相应增加。最常见的模式涉及到松动假体水平的骨折（B2）。B2 PFF 具有独特的机械病理发生机制，与抛光锥形滑动骨水泥固定柄在水泥中下沉的趋势有关。与其他骨水泥设计相比，这种柄具有更高的 PFF 风险。来自国家登记处的大量数据表明，锥形滑动原理的应用增加导致了高度抛光、极低摩擦骨水泥假体的出现。这些假体有在水泥内迁移的倾向，增加了 B2 PFF 的风险。这可以解释钴铬柄与 PFF 之间的强烈关联。PFF 是否是抛光锥形滑动柄的失效模式，而不是无菌性松动？既定的观点认为，B2 PFF 应该通过翻修手术来治疗。有大量新的证据表明，在某些情况下，固定的结果至少与翻修关节置换术相当，手术时间更短，输血需求减少，脱位风险降低。对于带有完整骨水泥界面的固定抛光锥形滑动柄的 B2 PFF 尤其如此。我们概述了对 B2 PFF 的理解进展，特别参考了机械病理发生机制和固定的适应症。
