Roblot Galdéric, Demester Julien, Brunschweiler Benoit, Gabrion Antoine, Rahab Riadh, Mertl Patrice
Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 1 rond-point du Pr Cabrol, 80054 Amiens Cedex, France.
Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 1 rond-point du Pr Cabrol, 80054 Amiens Cedex, France.
Orthop Traumatol Surg Res. 2025 Sep;111(5):104189. doi: 10.1016/j.otsr.2025.104189. Epub 2025 Feb 17.
Periprosthetic hip fracture is a serious complication associated with increased mortality and impaired autonomy. When the implant is loosened, the standard treatment involves prosthetic revision. However, recent studies suggest that these cases can be successfully treated with fixation without prosthetic exchange. This strategy seems relevant for elderly and frail patients with fractures around hemiarthroplasties but it has not yet been investigated in France. Therefore we did a retrospective comparative investigation aiming to compare postoperative complications (i.e., death within one month or reintervention) between osteosynthesis and prosthetic revision in elderly patients with Vancouver B fractures around polished tapered stem hemiarthroplasties.
We hypothesized that there would be no significant difference between osteosynthesis and prosthetic revision.
In a single-university-center, all patients treated between 2005 and 2024 for periprosthetic fractures after cemented hemiarthroplasty were included in a retrospective observational study. A total of 92 patients were included, with an average age of 88.7 years (range, 77-107), mostly institutionalized (58%) and with multiple comorbidities, as indicated by a mean ASA score of 2.75 (range: 2-4) and a mean Charlson Comorbidity Index of 6.4 (range: 4-10); the average time between HHA and PPF occurrence was 2.1 years (range: 7-5679 days). The primary outcome was a composite criterion including the occurrence of a complication requiring reintervention or death within one month postoperatively. Group comparability was established using a propensity score.
The mean follow-up was 665 days, with the longest follow-up reaching 5704 days. No significant difference was observed in the primary outcome between the osteosynthesis group (n = 19/39 patients, (48.71%)) and the revision group (n = 16/39 patients, (41.02%)) (p = 0.637). Osteosynthesis demonstrated significantly shorter operative time (96 min vs. 167 min, p < 0.001), reduced blood loss (428 mL vs. 874 mL, p < 0.001), shorter hospital stays (9.17 days vs. 13.39 days, p < 0.001), and better autonomy preservation (loss of 1.09 Parker score points vs. 1.97 points, p < 0.001) compared to revision surgery. The 1-year mortality rate was 29,3% (27/92). The reintervention rate was 27.2% (25/92). The main causes of reintervention were dislocations, accounting for 13% (12/92) of cases, (occurring in 9.4% (5/53) of patients in the osteosynthesis group and 17.9% (7/39) in the revision group. The second most common reintervention cause was infection, which accounted for 11% (10/92) of cases, (occurring in 7.5% (4/53) of patients in the osteosynthesis group and 15.4% (6/39) in the revision group).
This result supports the idea that, for HHA's PPF, the Vancouver-SOFCOT recommendations can be adapted. For all type B fractures, if the fracture can be reduced and the cement mantle is well-fixed to the bone and of good quality, osteosynthesis is also a reliable option.
III; Retrospective comparative study.
人工髋关节周围骨折是一种严重的并发症，与死亡率增加和自主性受损有关。当植入物松动时，标准治疗方法是进行假体翻修。然而，最近的研究表明，这些病例可以通过固定治疗而无需更换假体而成功治愈。这种策略似乎适用于半关节置换周围骨折的老年体弱患者，但在法国尚未进行研究。因此，我们进行了一项回顾性比较研究，旨在比较老年温哥华B型骨折患者在抛光锥形柄半关节置换周围进行骨固定术和假体翻修术后的并发症（即术后1个月内死亡或再次干预）情况。
我们假设骨固定术和假体翻修术之间没有显著差异。
在一所大学中心，对2005年至2024年期间接受骨水泥半关节置换术后人工关节周围骨折治疗的所有患者进行了一项回顾性观察研究。共纳入92例患者，平均年龄88.7岁（范围77 - 107岁），大多数为机构护理患者（58%），且合并多种疾病，平均美国麻醉医师协会（ASA）评分为2.75（范围：2 - 4），平均查尔森合并症指数为6.4（范围：4 - 10）；半髋关节置换术（HHA）与假体周围骨折（PPF）发生之间的平均时间为2.1年（范围：7 - 5679天）。主要结局是一个综合标准，包括术后1个月内需要再次干预或死亡的并发症的发生情况。使用倾向评分建立组间可比性。
平均随访665天（最长随访达5704天）。骨固定术组（n = 19/39例患者，（48.71%））和翻修术组（n = 16/39例患者，（41.02%））在主要结局方面未观察到显著差异（p = 0.637）。与翻修手术相比，骨固定术的手术时间显著缩短（96分钟对167分钟，p < 0.001），失血量减少（428毫升对874毫升，p < 0.001），住院时间缩短（9.17天对13.39天，p < 0.001），并且在自主性保留方面更好（帕克评分损失1.09分对1.97分，p < 0.001）。1年死亡率为29.3%（27/92）。再次干预率为27.2%（25/92）。再次干预的主要原因是脱位，占病例的13%（12/92），（在骨固定术组的患者中发生率为9.4%（5/53），在翻修术组中为17.9%（7/39））。第二常见的再次干预原因是感染，占病例的11%（10/92），（在骨固定术组的患者中发生率为7.5%（4/53），在翻修术组中为15.4%（6/39））。
该结果支持这样一种观点，即对于半髋关节置换术的假体周围骨折，温哥华 - 法国矫形外科医生学会（SOFCOT）的建议可以调整。对于所有B型骨折，如果骨折能够复位且骨水泥壳与骨固定良好且质量良好，骨固定术也是一种可靠的选择。
III级；回顾性比较研究。
