Luzzi Andrew, Lakra Akshay, Murtaugh Taylor, Shah Roshan P, Cooper H John, Geller Jeffrey A
Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA.
Arthroplast Today. 2024 Aug 13;29:101418. doi: 10.1016/j.artd.2024.101418. eCollection 2024 Oct.
Periprosthetic fractures (PPFs) after total joint arthroplasty (TJA) can be devastating, yet their long-term impact has not been well described. The aim of this study is to compare the long-term outcomes of patients who sustained a PPF about a TJA with those of patients who underwent an uncomplicated TJA.
Patients who sustained a PPF after primary TJA between 2005 and 2014 were identified. Seventeen patients with a minimum 2-year follow-up (PPF cohort) were compared to a matched cohort of 67 patients who underwent uncomplicated TJA. Demographic data, comorbidities, surgical details, and complications were analyzed. Quality of life and functional outcomes were assessed with 12-Item Short Form Health Survey (SF-12), Western Ontario and McMasdter Universities Arthritis Index (WOMAC), and Knee Society Function Score.
The overall complication rate was 41.2% in the PPF group, including 3 additional fractures (17.6%), 2 wound infections (11.8%), one prosthetic joint infection (5.8%), and one painful patellar hardware necessitating removal (5.8%). At 2 years, both physical and mental components of the SF-12 were significantly lower for the PPF cohort vs control (SF-12-P, 28.7 ± 4.4 vs 40.8 ± 10.3, < .001, SF-12-M, 36.7 ± 5.07 vs 55.0 ± 8.19, < .0001). WOMAC pain and function scores were also significantly worse in the PPF cohort vs control at 2 years (WOMAC-pain, 38.8 ± 29.9 vs 87.4 ± 22.1; < .0001, WOMAC-function, 40.7 ± 8.7 vs 76.1 ± 20.3; < .0001). At 2 years, score improvements from prearthroplasty baseline were significantly greater in the control cohort vs PPF for SF-12-physical, WOMAC-pain, and WOMAC-function.
Patients who sustained PPFs following TJA have poor long-term outcomes despite appropriate treatment. These results can help counsel patients and encourage heightened efforts to minimize the risk of PPF.
Level III.
全关节置换术（TJA）后假体周围骨折（PPF）可能具有破坏性，但其长期影响尚未得到充分描述。本研究的目的是比较发生TJA相关PPF的患者与接受无并发症TJA的患者的长期结局。
确定2005年至2014年间初次TJA后发生PPF的患者。将17例至少随访2年的患者（PPF队列）与67例接受无并发症TJA的匹配队列进行比较。分析人口统计学数据、合并症、手术细节和并发症。使用12项简短健康调查（SF-12）、西安大略和麦克马斯特大学关节炎指数（WOMAC）以及膝关节协会功能评分评估生活质量和功能结局。
PPF组的总体并发症发生率为41.2%，包括3例额外骨折（17.6%）、2例伤口感染（11.8%）、1例假体关节感染（5.8%）和1例需要取出的疼痛性髌骨内固定物（5.8%）。在2年时，PPF队列的SF-12身体和心理成分均显著低于对照组（SF-12-P，28.7±4.4对40.8±10.3，<.001；SF-12-M，36.7±5.07对55.0±8.19，<.0001）。在2年时，PPF队列的WOMAC疼痛和功能评分也显著低于对照组（WOMAC疼痛，38.8±29.9对87.4±22.1；<.0001；WOMAC功能，40.7±8.7对76.1±20.3；<.0001）。在2年时，对照组在SF-12身体、WOMAC疼痛和WOMAC功能方面从关节置换术前基线的评分改善显著大于PPF队列。
TJA后发生PPF的患者尽管接受了适当治疗，但长期结局仍较差。这些结果有助于为患者提供咨询，并鼓励加大努力以尽量降低PPF的风险。
三级。
