Periprosthetic Fracture Research Articles

Mid- to long-term periprosthetic bone density changes after cementless short stem hip arthroplasty in elderly: A clinical and radiological analysis

IntroductionShort stem prostheses were originally designed for younger and more active patients. In recent years, they have been increasingly offered to older patients. This study evaluates the mid-to long-term survival of a short stem prosthesis and the changes in periprosthetic bone density following implantation of a cementless short hip stem in patients over 60 years of age. Methods118 patients aged over 60 received short stem prostheses. Clinical examination included Harris Hip Score (HHS) and Hip Disability and Osteoarthritis Outcome Score (HOOS). 93 patients were followed clinically for at least five years. 53 patients underwent dual-energy x-ray absorptiometry (DXA) and radiographic evaluation. Follow-up intervals were preoperative and postoperative (t0), at approximately six months (t1), at approximately two years (t2), and at approximately five years or later (t3). ResultsOver a mean 6.7-year observation period for all 118 patients, one stem revision occurred due to a traumatic periprosthetic stem fracture. The five-year survival rate for the endpoint survival of the Metha® stem in 95 at-risk patients is 99.2%. HHS improved significantly from t0 55.3 ± 11.5 (range 30–79) to t3 95.3 ± 8.6 (range 57–100) at a mean of 8.0 years (p < 0.001). HOOS improved significantly in each subscale (p < 0.001). Bone mineral density (BMD) was available for review in 53 patients after a mean of 7.1 years. BMD increased from t0 to t3 in region of interest (ROI) 3 (+0.4%) and ROI 6 (+2.9%) and decreased in ROI 1 (−10.3%), ROI 2 (−9.8%), ROI 4 (−5.3%), ROI 5 (−3.4%) and ROI 7 (−23.1%). ConclusionsThe evaluated short stem prosthesis shows a remarkably high survival rate in elderly patients, accompanied by excellent clinical results. Load transfer measurements show a metaphyseal-diaphyseal pattern with a trend towards increased diaphyseal transfer over the period observed.

Treatment of periprosthetic fracture Vancouver B2-B3 in cementless total hip arthroplasty: are we able to predict stem mobilization?

Treatment of periprosthetic fracture Vancouver B2-B3 in cementless total hip arthroplasty: are we able to predict stem mobilization?

Planovalgus Foot Deformity in Patients Undergoing Total Hip Arthroplasty Is Associated With Increased Risk of Falls, Implant-Related Complications, and Revisions: A Case-Control Analysis

BackgroundPes planus occurs due to the loss of the longitudinal arch of the foot, resulting in altered gait mechanics. This may lead to increased complications following total hip arthroplasty (THA). Thus, the aim of this study was to assess the effects that pes planus has on rates of falls, implant complications, fall-related injuries, and times to revision among THA patients. MethodsA retrospective review of a private insurance claims database was conducted from 2010 to 2021. Patients who had a diagnosis of congenital or acquired pes planus and cases of THA were identified. Patients undergoing THA with a diagnosis of pes planus were matched to control patients 1:5 based on age, sex, and comorbidity profiles. Logistic regression was utilized to assess for differences in complication rates. ResultsA total of 3,622 pes planus patients were matched to 18,094 control patients. The pes planus group had significantly higher rates of falls than the control group (6.93 versus 2.97%, OR [odds ratio]: 2.43; CI [confidence interval]: 2.09 to 2.84; P < .001). Pes planus patients also had significantly greater odds of dislocation (OR: 1.89; CI: 1.58 to 2.27; P < .001), mechanical loosening (OR: 2.43; CI: 2.09 to 2.84; P = .019), and periprosthetic fracture (OR: 2.43; CI: 2.09 to 2.84; P < .001). The pes planus group had significantly greater rates of proximal humerus fractures (P = .008), but no difference was seen in distal radius fractures (P = .102). The time to revision was significantly shorter in the pes planus group (190 versus 554 days, P < .001). ConclusionsPes planus in patients undergoing THA is associated with increased risk of complications and faster time to revision. These findings may allow orthopaedic surgeons to identify those patients at risk and allow for more educated patient counseling and operative planning.

Prise en charge des fractures périprothétiques de la hanche : état actuel et perspectives; expérience du service de traumatologie et d’orthopédie CHU Mohammed VI de Marrakech

The increase in hip arthroplasties predicts a rise in periprosthetic fractures in Morocco, posing challenges for orthopedic surgeons. Therapeutic strategies vary considerably, highlighting the absence of a universally accepted treatment protocol. To analyze the management of per-prosthetic hip fractures, while addressing the challenges associated with them. This was a retrospective study, conducted in the trauma-orthopedics department between December 2015 and November 2022. Nineteen patients who presented to the hospital with fractures around a hip prosthesis were included. Nineteen periprosthetic fractures were observed. The majority of patients (68%) were women, with an average age of 68. The Vancouver classification showed that 52.6% of the fractures were type B1, and 21.1% type C, while the other fracture types were distributed differently. These fractures were mainly associated with diagnoses such as femoral neck fracture (63.2%) and coxarthrosis (31.6%). We observed variations in treatment recommendations and results between the different series analyzed. We noted discrepancies with certain series concerning fracture types and therapeutic choices. However, in our series, we achieved satisfactory results, with successful consolidation and the absence of complications in all patients. These results underline the importance of an individualized approach to fracture management, taking into account the specificities of each case.

Comparison of clinical results of flattapered and rectangular stems in partial hip replacement based on proximal femur fracture

Aim: Hemiarthroplasty is commonly used in proximal femur fractures to provide early mobilization and weight bearing to the patient. Cemented and cementless femoral stems are commonly used in this procedure. Cementless prostheses have many advantages and disadvantages, and their relevance to stem design is controversial. This study aimed to compare flat-tapered and rectangular femoral stems in hemiarthroplasty. Methods: The study population consisted of a third-level hospital’s archive orthopedics and traumatology clinic. Our study was retrospective. A total of 176 patients who underwent cementless hemiarthroplasty in proximal femoral fractures between January 2017 and January 2022 were included in the study. Within these protocols, 64 patients underwent hemiarthroplasty using a flat-tapered stem (Group 1), and 58 patients underwent hemiarthroplasty using a rectangular stem (Group 2). At the last follow-up of the patients, the Harris hip score, Visual Analogue Scale, and early and long-term complications were evaluated. Results: No significant differences among the patients were observed regarding Harris hip scores and Visual Analogue Scale values. The study groups were analyzed in terms of developing complications. Similar results were found in both groups regarding periprosthetic femur fractures. Conclusion: Our study found no significant difference between flat-tapered and rectangular stems in terms of clinical outcomes and periprosthetic femur fracture in cases of cementless hemiarthroplasty. As a result, rectangular stems can be safely preferred in hemiarthroplasty.

Retrograde intramedullary nail fixation with oblique fixed angle screws versus locking plates in periprosthetic supracondylar fractures after total knee arthroplasty

PurposeCommon surgical procedures in the treatment of periprosthetic distal femur fractures (PPFF) include osteosynthesis with fixed angle locking plates (LP) and retrograde intramedullary nails (RIN). This study aimed to compare LPs to RINs with oblique fixed angle screws in terms of complications, radiographic results and functional outcome.Methods63 PPFF in 59 patients who underwent treatment in between 2009 and 2020 were included and retrospectively reviewed. The anatomic lateral and posterior distal femoral angle (aLDFA and aPDFA) were measured on post-surgery radiographs. The Fracture Mobility Score (FMS) pre- and post-surgery, information about perceived instability in the operated leg and the level of pain were obtained via a questionnaire and previous follow-up (FU) examinations in 30 patients (32 fractures).ResultsThe collective (median age: 78 years) included 22 fractures treated with a RIN and 41 fractures fixed with a LP. There was no difference in the occurrence of complications (median FU: 21.5 months) however the rate of implant failures requiring an implant replacement was higher in fractures treated with a LP (p = 0.043). The aPDFA was greater in fractures treated with a RIN (p = 0.04). The functional outcome was comparable between both groups (median FU: 24.5 months) with a lower outcome in the post-surgery FMS (p = < 0.001).ConclusionFractures treated with RIN resulted in an increased recurvation of the femur however the rate of complications and the functional outcome were comparable between the groups. The need for implant replacements following complications was higher in the LP group.

Rates of interlock screw back-out are high with the retrograde femoral nailing advanced system for distal femur fractures

PurposeThe retrograde femoral nailing advanced (RFNA) system (DePuy synthes) is a commonly used implant for the fixation of low distal femur and periprosthetic fractures. There is concern that the rate of distal interlock screw back-out may be higher for the RFNA compared to other nails (ON). The purpose of this study was to evaluate the incidence of interlock screw back-out and associated screw removal for RFNA versus ON, along with associated risk factors.MethodsA retrospective comparative study of patients who underwent retrograde nailing for a distal femur fracture at an academic level one trauma center was performed. The incidence of distal interlock screw back-out and need for screw removal were compared for RFNA versus a propensity score matched cohort who received other nails.ResultsOne hundred and ten patients underwent retrograde nailing with the RFNA for a distal femur fracture from 2015 to 2022 (average age: 66, BMI: 32, 52.7% smokers, 54.5% female, 61.8%). There was a significantly higher rate of interlock back-out in the RFNA group compared to the ON (27 patients, 24.5% vs 12 patients, 10.9%, p = 0.01), which occurred 6.3 weeks postoperatively. Screw removal rates for back-out were not significantly different for the RFNA group versus ON (8 patients, 7.3% vs 3 patients, 2.7%, p = 0.12).ConclusionIn this retrospective comparative study of distal femur fractures treated with retrograde nailing, the RFNA implant was associated with an increased risk of distal interlock screw back-out compared to other nails.

Periprosthetic proximal humerus fractures require an individualized treatment approach-results of a multicenter retrospective study.

In the last years, there has been increasing use of shoulder arthroplasty. As a result, an increasing incidence of periprosthetic humerus fractures (PPHF) is expected. Therefore, this retrospective, multicenter analysis aimed to collect demographic data from patients with PPHF, their treatment strategies, and associated complications. Demographics of patients with PPHF were collected retrospectively from the database of six trauma hospitals between January 2000 and December 2020. All fractures were categorized according to the Wright and Cofield, and Worland classifications. In addition, the type of treatment for PPHF, as well as subsequent complications, were evaluated. A total of 72 patients with a PPHF were identified. The mean age of the 55 female and 17 male patients was 77years. PPHF occurred a mean of 50months after primary arthroplasty implantation, almost exclusively as a result of a fall from standing height (n = 67). In-situ implant was a RTSA in 40 patients and a hemiarthroplasty in 32 patients. More than half of the fractures (n = 38) were type B fractures, according to Wright and Cofield. According to Worland, the majority of patients also had a type B fracture (type B1 (n = 22), type B2 (n = 28), type B3 (n = 10)). Associated comorbidities were found in 21 patients. A total of 31 patients were treated non-operatively, 27 with Open Reduction Internal Fixation (ORIF), and 14 with a revision arthroplasty. Nine primary radial nerve palsies were found (pre-operatively), and seven secondarily (post-operatively). Nine patients suffered from non-union (ORIF 4, non operative 4,stem replacement 1). The treatment strategy for PPHF is primarily tailored to the individual patient. Decisive factors such as patient's age, fracture type, and primary palsies have to be considered for optimal treatment. In type B1 fractures, there is a recommendation for ORIF because of high non-union rates under non-operative treatment. In contrast, in type B2 fractures, a non-operative approach should be preferred, provided there are no radial nerve lesions. Level IV, epidemiologic study.

The influence of operation time for hip hemiarthroplasty on complication rates and mortality in patients with femoral neck fracture: a retrospective data analysis.

The aim of the present study was to investigate the influence of various factors, in particular operation time, on mortality and complication rates in patients with femoral neck fractures who have undergone hip hemiarthroplasty (HHA) and to determine a cut-off value above which mortality and complication rates increase significantly. Cases of patients with femoral neck fracture treated with HHA between 1 January 2017 and 31 December 2023 were screened for eligibility. Multiple logistic regressions were calculated to determine which factors (patient age, experience of surgeon, patient sex, ASA score, time to surgery, operation time) influenced the incidence of complications and mortality. The exact cut-off value for complications and mortality was determined using the Youden index of the ROC curve (sensitivity vs. specificity) of logistic regression. A total of 552 patients were considered eligible for this study. During the 90-day follow-up period after HHA, 50 deaths and 34 complications were recorded, giving a mortality rate of 9.1%, and a complication rate of 6.2%. Of the 34 complications recorded, 32.3% were infections, 14.7% dislocations, 20.7% trochanteric avulsions, 11.8% periprosthetic fractures, 11.8% nerve injuries, and 8.8% deep vein thrombosis. The odds ratio (OR) of a patient experiencing a complication is 2.2% higher for every minute increase in operation time (Exponential Beta - 1 = 0.022; p = 0.0363). The OR of a patient dying is 8.8% higher for each year increase in age (Exponential Beta - 1 = 0.088; p = 0.0007). When surgery was performed by a certified orthopaedic surgeon the mortality rate lowered by 61.5% in comparison to the surgery performed by a trainee (1 - Exponential Beta = 0.594; p = 0.0120). Male patients have a 168.7% higher OR for mortality than female patients (Exponential Beta - 1 = 1.687; p = 0.0017). Patients with an operation time of ≥ 86min. have a 111.8% higher OR for mortality than patients with an operation time of < 86min. (Exponential Beta - 1 = 1.118). This retrospective data analysis found that the risk of a patient experiencing a complication was 2.2% higher for every minute increase in operation time. Patients with an operation time above the cut-off of 86min had a 111.8% higher risk of mortality than those with an operation time below the cut-off. Other influencing factors that operators should be aware of include patient age, male sex, and operator experience.

Septic complications are on the rise and aseptic loosening has decreased in total joint arthroplasty: an updated complication based analysis using worldwide arthroplasty registers.

A decade ago, a comprehensive study was conducted to investigate the reasons for revision surgeries and their respective frequencies in cases of total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on a complication-based analysis of joint replacement registries. The aim of the present study was to determine whether the causes and risks of their occurrence have changed over the last ten years and to present an updated analysis. A systematic review of national arthroplasty registries from seven countries examined the causes and rates of revisions of THA and TKA. The study focused on a descriptive analysis that provided an updated overview without statistical significance values. The most common causes for revisions of THA were aseptic loosening (35.1%), deep infection (18.2%), dislocation/instability (15.9%), and periprosthetic fractures (11.4%). The most common causes for revisions of TKA were deep infection (21.6%), aseptic loosening (18.3%), instability (14.1%), and pain (10.9%). The findings of this study revealed significant shifts in the underlying causes of revision surgeries in the last decade. Notably, septic complications emerged as the predominant reason for revision of primary TKA, while they also gained prominence as a cause of failure of THA. Although aseptic loosening remains the primary cause for re-operation of THA, the relative risk has decreased for both THA and TKA.

Unplanned emergency department visits within 90 days of hip hemiarthroplasty for osteoporotic femoral neck fractures: Reasons, risks, and mortalities

Bipolar hemiarthroplasty is commonly performed to treat displaced femoral neck fractures in osteoporotic patients. This study aimed to assess the occurrence and outcomes of unplanned return visits to the emergency department (ED) within 90 days following bipolar hemiarthroplasty for displaced femoral neck fractures. The clinical data of 1322 consecutive patients who underwent bipolar hemiarthroplasty for osteoporotic femoral neck fractures at a tertiary medical center were analyzed. Data from the patients' electronic medical records, including demographic information, comorbidities, and operative details, were collected. The risk factors and mortality rates were analyzed. Within 90 days after surgery, 19.9% of patients returned to the ED. Surgery-related reasons accounted for 20.2% of the patient's returns. Older age, a high Charlson comorbidity index score, chronic kidney disease, and a history of cancer were identified as significant risk factors for unplanned ED visits. Patients with uncemented implants had a significantly greater risk of returning to the ED due to periprosthetic fractures than did those with cemented implants (P=0.04). Patients who returned to the ED within 90 days had an almost fivefold greater 1-year mortality rate (15.2% vs 3.1%, P<0.001) and a greater overall mortality rate (26.2% vs 10.5%, P<0.001). This study highlights the importance of identifying risk factors for unplanned ED visits after bipolar hemiarthroplasty, which may contribute to a better prognosis. Consideration should be given to the use of cemented implants for hemiarthroplasty, as uncemented implants are associated with a greater risk of periprosthetic fractures.

Low Rate of Early Periprosthetic Fractures in Direct Anterior Total Hip Arthroplasty with a Triple-Tapered Wedge Stem.

Utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) has been steadily increasing in recent years. While the DAA may offer some benefits compared to other approaches, there are still risks involved including relatively higher rates of periprosthetic femur fractures, especially when combined with cementless femoral stem use. The purpose of this study is to evaluate the early postoperative femoral complications with a short triple-wedge tapered stem used in primary THA via a DAA. A retrospective review was conducted of the arthroplasty registry of our institution from April 2022 to August 2023 to identify patients who underwent a primary THA via a DAA with the Short Medacta Stem (SMS) (Medacta International, Castel San Pietro, Switzerland). Patients were excluded if the stem was used for a revision surgery, they were within 90 days of surgery, or they refused research consent. Inclusion criteria was met in 262 patients (302 hips). Data was collected after reviewing the chart, and reports and radiographic measurements, including Dorr type and canal fit ratios, were obtained from preoperative and postoperative radiographs, respectively. A total of 302 total hips were included, 161 patients were male (53.3%) and 141 were female (46.7%), with an average age of 66.5 years (27-88, +/- 10.7 years). Average follow up was 0.3 years (range, 0.05-1.71 years). The majority of patients had a Dorr B femur (81.7%). The Median stem size used was an 8 (range, 2-15), and 89.4% of those had a collar. Average canal fill ratio was 0.83 (range, 0.43-0.98, +/- 0.07). Overall, there were two Vancouver B2a periprosthetic femoral shaft fractures (0.66%) that required revision surgery to a modular stem. In addition, there were two Vancouver Ag greater trochanteric fractures (0.66%) with acceptable alignment that did not require revision surgery. Demographic information about the patients with femoral complications is summarized in Table I. Average age of patients with femoral complications was 69.5 years, with an average canal fit ratio of 0.88. We found that the triple-wedge implant had a low rate of early femoral complication in primary THA from an anterior approach and is safe for use in THA from a DAA. More follow up is needed to evaluate continuing implant survivorship and patient outcomes.

Total hip and knee arthroplasty after lower extremity amputation in a military population

IntroductionThe military includes lower extremity amputees requiring arthroplasty; however, there is little literature on this population. The primary aim of this study was to report demographics and clinical factors in...

Clinical differences between periprosthetic and native distal femur fractures: a comparative observational study

IntroductionThe incidence of periprosthetic distal femur fractures (PDFF) is increasing as the number of total knee replacements becomes more common. This study compared the demographics, fracture characteristics, treatment, and outcomes of periprosthetic versus native distal femur fractures (NDFF).Materials and methodsThis was a retrospective cohort study of patients ≥ 18 who underwent surgical fixation of NDFF or PDFF from 2012 to 2020 at a level-1 trauma center. The main variables collected included demographics, AO/OTA fracture classification, fixation construct, concomitant fractures, polytrauma rates, bone density, and reduction quality. Primary outcomes were unexpected return to the operating room (UROR), hospital length of stay, and quality of reduction. T-tests, Fisher’s exact tests, and multivariate analyses were used for statistical analysis.Results209 patients were identified, including 70 PDFF and 139 NDFF. PDFF patients were elderly females (81%) with isolated (80%) and comminuted (85%) 33 A.3 (71%) fractures. NDFF patients included 53% females, were commonly middle-aged, and displayed comminuted (92%) 33 C.2 fractures. 48% of NDFF patients had concomitant fractures. Intramedullary nailing was the primary fixation for both groups, followed by nail-plate combination (37%) for PDFF and lateral locking plates (21%) for NDFF. NDFF patients experienced significantly longer hospital stays, higher UROR rates, and worse quality of reduction (p < 0.05). PDFF patients had a significantly greater prevalence of low bone density (p < 0.05).ConclusionPDFF occur as isolated injuries with significant metaphyseal comminution in elderly females with low bone quality. NDFF commonly occurs in younger patients with less metaphyseal comminution and concomitant fractures. Intramedullary nailing was the most common treatment for both groups, although preference for nail-plate combination fixation is increasing. NDFF type 33 C fractures are at greater risk of UROR.

Comparison of the early postoperative outcomes of cementless and cemented medial unicompartmental knee arthroplasty.

The primary objective of this registry-based study was to compare patient-reported outcomes of cementless and cemented medial unicompartmental knee arthroplasty (UKA) during the first postoperative year. The secondary objective was to assess one- and three-year implant survival of both fixation techniques. We analyzed 10,862 cementless and 7,917 cemented UKA cases enrolled in the Dutch Arthroplasty Registry, operated between 2017 and 2021. Pre- to postoperative change in outcomes at six and 12 months' follow-up were compared using mixed model analyses. Kaplan-Meier and Cox regression models were applied to quantify differences in implant survival. Adjustments were made for patient-specific variables and annual hospital volume. Change from baseline in the Oxford Knee Score (OKS) and activity-related pain was comparable between groups. Adjustment for covariates demonstrated a minimally greater decrease in rest-related pain in the cemented group (β = -0.09 (95% confidence interval (CI) -0.16 to -0.01)). Cementless fixation was associated with a higher probability of achieving an excellent OKS outcome (> 41 points) (adjusted odds ratio 1.2 (95% CI 1.1 to 1.3)). The likelihood of one-year implant survival was greater for cemented implants (adjusted hazard ratio (HR) 1.35 (95% CI 1.01 to 1.71)), with higher revision rates for periprosthetic fractures of cementless implants. During two to three years' follow-up, the likelihood of implant survival was non-significantly greater for cementless UKA (adjusted HR 0.64 (95% CI 0.40 to 1.04)), primarily due to increased revision rates for tibial loosening of cemented implants. Cementless and cemented medial UKA led to comparable improvement in physical function and pain reduction during the initial postoperative year, albeit with a greater likelihood of achieving excellent OKS outcomes after cementless UKA. Anticipated differences in early physical function and pain should not be a decisive factor in the choice of fixation technique. However, surgeons should consider the differences in short- and long-term implant survival when deciding which implant to use.

National Institute of Health and Care Excellence Guidelines for Displaced Intracapsular Hip Fractures: Examining Satisfaction With the Guidelines and Effects on Outcomes

BackgroundThe objectives of the study were to: (1) evaluate satisfaction with the new 2023 National Institute of Health and Care Excellence (NICE) criteria for selecting total hip arthroplasty (THA) over hemiarthroplasty and surgical recommendations for treatment of displaced intracapsular hip fractures; (2) describe why THA is performed when NICE criteria are not met; and (3) determine whether satisfaction with these guidelines is associated with improved outcomes. MethodsA retrospective chart review of patients who had a displaced intracapsular hip fracture treated with THA at a single tertiary academic center between 2010 and 2022 was performed. Preoperative patient characteristics were reviewed to determine if the indication for THA met NICE criteria. Operative details, perioperative complications, reoperation, and revision arthroplasty within 12 months of surgery were recorded. ResultsData from 196 patients (63% women; age 67 ± 10 years) were used. There were 161 THAs (82.1%) that satisfied NICE criteria. The 2 most common reasons for performing a THA when NICE criteria were not met (n = 35) included preoperative radiographic osteoarthritis (Tönnis grade ≥ 2; 48.6%) and decreased patient age (< 65 years; 31.5%). Satisfaction with the NICE criteria was associated with fewer perioperative complications (0.6 versus 37.1%; P < .001), reoperations (0.6 versus 31.4%; P < .001), and revisions (0.6 versus 28.6%; P < .001). The most common reason for revision was periprosthetic fracture, possibly secondary to the use of uncemented femoral stems (171 of 196, 87.2%). ConclusionsSatisfaction with the new NICE criteria is associated with improved perioperative outcomes. Further studies are necessary to determine if preexisting hip osteoarthritis and younger age merit consideration in patient selection.

The effect of a collar on primary stability of standard and undersized cementless hip stems: a biomechanical study

IntroductionAseptic loosening and periprosthetic fractures are main reasons for revision after THA. Quite different from most other stem systems, Corail cementless hip stems show better survival rates than their cemented counterpart, which can possibly be explained by the use of a collar. The study aimed to investigate primary stability with standard and undersized hip stems both collared and collarless.Materials and methodsPrimary stability of cementless, collared and collarless, femoral stems was measured in artificial bones using both undersized and standard size. After preconditioning, 3D micromotion was measured under cyclic loading at the bone-implant interface.ResultsThe use of a collar resulted in higher micromotion within the same stem size but showed no statistically significant difference for both standard and undersized hip stems. The collared and collarless undersized stems showed no significant differences in 3D micromotion at the upper measuring positions compared to the standard stem size. Micromotion was significantly higher in the distal measuring positions, with and without collar, for the undersized stems (vs. standard collarless stem size).ConclusionThe key finding is that the collarless and collared Corail hip stems, within one stem size, showed no significant differences in primary stability. Undersized stems showed significantly higher micromotion in the distal area both with and without collar.

Total Knee Arthroplasty With or Without Prior Bariatric Surgery: A Systematic Review and Meta-Analysis

BackgroundStudies comparing the outcomes of bariatric surgery followed by total knee arthroplasty (TKA) versus TKA alone in obese patients have disparate results. This systematic review and meta-analysis sought to compare TKA with and without prior bariatric surgery in obese patients. MethodsMEDLINE, PubMed, and Embase were searched from inception to April 9, 2023. There were twelve included studies that yielded 2,876,547 patients, of whom 62,818 and 2,813,729 underwent TKA with and without prior bariatric surgery, respectively. Primary outcomes were medical complications (ie, urinary tract infection, pneumonia, renal failure, respiratory failure, venous thromboembolism [VTE], arrhythmia, myocardial infarction, and stroke); surgical complications (ie, wound complications [eg, infection, hematoma, dehiscence, delayed wound healing, and seroma], periprosthetic joint infection, mechanical complications, periprosthetic fracture, knee stiffness, and failed hardware); revision, and mortality. Secondary outcomes were blood transfusion, length of stay (day), and readmission. ResultsThe odds ratios (OR) of 90-day VTE (OR = 0.75 [0.66, 0.85], P < .00001), 90-day stroke (OR = 0.58 [0.41, 0.81], P = .002), and 1-year periprosthetic fracture (OR = 0.74 [0.55, 0.99], P = .04) were lower in those who underwent bariatric surgery before TKA. Although the mean difference in hospital stays (−0.19 days [−0.23, −0.15], P < .00001) was statistically less in those who underwent bariatric surgery before TKA, it was not clinically relevant. The other outcomes were similar between the groups. ConclusionsBariatric surgery before TKA is beneficial in terms of a lower risk of VTE, stroke, and periprosthetic fracture. This analysis suggests surgeons consider discussing bariatric surgery before TKA in obese patients, especially those who are at risk of VTE and stroke.

The Avantage ® dual mobility cup in primary total hip arthroplasty: A registry study

BackgroundAvantage Cup has been widely used in dual mobility implants. However, in Swedish Registry, the outcome of the Avantage Cup is reported with higher implants revision compared to control. The aim of our study was to verify if the same results are present in the Registry of Prosthetic Orthopedic Implants (RIPO) of Emilia Romagna (ER, Italy), as the Avantage cup was the most implanted dual mobility cup for a long follow-up reported in this Registry (2000–2012). Furthermore, we assessed the survival rate of the implant over the time. MethodsWe included all patients that underwent a primary THA using the Avantage cup during the period 2000–2020 in RIPO Registry. The survivorship of the primary THA implants was calculated and plotted according to Kaplan-Meier method. Results886 Avantage cups were included in the analysis. During the observational period 44 hips were revised. The most common reasons for revision were: periprosthetic fractures (PPF) (n = 7, 0.8 %), deep infection (n = 7, 0.8 %), and cup aseptic loosening (n = 13, 1.5 %).The survival rate of the implant was 96.8 % (95.3–97.8) at 5 years, 95.7 at 10 years (94.0–97.0) and 92.1 at 15 years (88.5–94.6). ConclusionIn conclusion, this study has demonstrated that the Avantage cup in primary hip arthroplasty implanted with a “friendly” femoral stem granted satisfactory long-term survival. Therefore, in the Swedish Registry, the cause of the poor results presented for Avantage Cup could be the thick, rough neck stem of the widely used Lubinus stem.

Successful treatment of a challenging periprosthetic femoral fracture on a premenopausal patient with a long history of immunosuppression

While immunosuppression provides relief and care in patients with rheumatic arthritis, the prolonged usage of steroids has been known to cause various and serious complications. While in older patients it is common to find those with a long history of immunosuppression, younger patients also suffer from its prolonged complications. We present a 38 year old heavily immunocompromised female patient with excellent compliance on which we operated on multiple occasions and have treated from 2019 to 2022. The patient was originally diagnosed with rheumatoid arthritis at age 7, and has been receiving high dose immunosuppressive medication. The patient received bilateral total hip arthroplasty during 2009 and 2013, and a Total Knee Arthroplasty (TKE) in 2011. Over the course of her postoperative recovery, she suffered from multiple cases of periprosthetic fractures. In October 2019, the patient again presented with spontaneous pain in her right thigh. She was then diagnosed with a Vancouver C type periprosthetic fracture on the right femur, and was referred and admitted to our level one Trauma Center in Szeged, Hungary. After multiple trials, the patient received a Locking Compression Plate (LCP) type Proximal Femoral Hook Plate (PFHP) with cable fixation, attachments and a bone allograft to reinforce stability and neutralize stress on the fractured area. Multiple and repetitive challenges can be expected in treating bony fractures of weight bearing lower limbs for heavily immunocompromised patients. The patient, despite her young age, had the osteological biology of a elderly patient, requiring us to take into consideration not only surgical components but biological components as well. With a multidisciplinary approach from osteological, biological, and surgical fields, successful results may be acquired even in these challenging cases.