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Periprosthetic AND Fracture

Samuel W King, Jonathan N Lamb, Emily S Cage, Hemant Pandit
Total joint arthroplasties are increasing worldwide in both frequency and prevalence. When successful, they offer great improvements in quality of life. However, fractures around implants are often difficult to manage and require prolonged inpatient stays in tertiary hospitals. Management may differ between surgeons, but most patients will be managed surgically if mobility or joint stability is threatened. Those affected are often at higher risk from surgery, are frailer and at higher risk of mortality and a lifelong reduction in mobility...
November 2018: Maturitas
Matt Blue, Christian Douthit, Joel Dennison, Cyrus Caroom, Mark Jenkins
A rare complication from computer-navigated total knee arthroplasty is a fracture through the insertion site of a tracking pin. These pins are inserted across the femoral and tibial shafts either bicortically, transcortically, or unicortically and have a reported fracture incidence of 1.38%, with all published cases occurring after bicortical pin placement. In this case, a 60-year-old female suffered a femoral shaft fracture through a unicortically inserted computer navigation tracking pin 6 weeks after total knee arthroplasty...
2018: Case Reports in Orthopedics
Brian T Grisez, Andrew E Hanselman, Karim W Boukhemis, Trapper A J Lalli, Brock A Lindsey
Traditional above-the-knee amputation prosthetics utilize a stump-socket interface that is well-known for skin/socket problems, sitting difficulty, disuse osteopenia, and increased work of ambulation. As a result, we evaluated a novel osseointegrated transcutaneous implant in a large animal. The implant was designed to promote osseointegration at the bone-implant interface and minimize complications. As proof of concept, four Dorset sheep underwent a two-stage surgery for forelimb placement of an osseointegrated transcutaneous implant utilizing Compress® technology (Biomet, Inc...
2018: Advances in Orthopedics
Nicholas J Greco, Adolph V Lombardi, Michael J Morris, Gerald R Hobbs, Keith R Berend
BACKGROUND: Despite growing interest in direct anterior approach total hip arthroplasty, perioperative femoral fracture and early aseptic loosening are increasingly recognized complications. Previous research has documented the role of surgeon experience in association with these femoral complications. The purpose of this study was to explore the relationship between femoral component design and early periprosthetic femoral complications. METHODS: This was an extension of previous work with an updated patient cohort of 5090 consecutive direct anterior primary total hip arthroplasties at a single institution with a single-taper, wedge femoral stem comprising 4 variants involving length and geometry: group 1, full-length, standard profile; group 2, full-length, reduced distal profile; group 3, short-length, standard profile; and group 4, short-length, reduced distal profile...
September 12, 2018: Journal of Arthroplasty
George Grammatopoulos, Wade Gofton, Zaid Jibri, Matthew Coyle, Johanna Dobransky, Cheryl Kreviazuk, Paul R Kim, Paul E Beaulé
BACKGROUND: Many patients undergo both THA and spinal arthrodesis, and those patients may not fare as well as those who undergo one procedure but not the other. The mechanisms of how spinal arthrodesis affects patient function after THA remain unclear. QUESTIONS/PURPOSES: The aims of our study were to (1) determine how patient-reported outcome measures (PROMs), including the Oxford hip score as well as dislocations and complications compare after THA between patients with and without spinal arthrodesis; (2) characterize sagittal pelvic changes in these patients that occur when moving between different functional positions and test for differences between patients with and without spinal arthrodesis; and (3) assess whether differences in sagittal pelvic dynamics are associated with PROMs, complications, and dislocations after THA...
May 30, 2018: Clinical Orthopaedics and related Research
Min Lu, Dayna Phillips
Posttraumatic arthritis accounts for a notable share of secondary osteoarthritis about the hip joint. Compared with total hip arthroplasty for primary osteoarthritis or inflammatory arthritis, total hip arthroplasty for posttraumatic arthritis offers greater technical challenges because of bone deformities and retained implants. Careful preoperative evaluation is necessary to prepare the approach, hardware removal strategy, and implants necessary to address bone deficiencies. Although arthroplasty is a highly successful procedure for posttraumatic arthritis, the results are less favorable than surgery for primary osteoarthritis...
October 4, 2018: Journal of the American Academy of Orthopaedic Surgeons
Jean-Louis Prudhon, Régis Verdier, Jacques H Caton
INTRODUCTION: Using a cementless fixation for total knee arthroplasty (TKA) is controversial. We hypothesized that cementless tibial base plate with a monoblock long stem (MLS) would provide secure tibial alignment and stable fixation when bone conditions were considered as poor for a cementless fixation. The purpose of this study was to compare the mean eight year survivorship of cementless standard keels (SK) vs cementless MLS. MATERIAL METHODS: We report a matched series of 98 cases of SK and 98 cases of MLS in patients with poor bone conditions...
October 3, 2018: International Orthopaedics
Nicholas M Brown, Gerard Engh, Kevin Fricka
Partial knee arthroplasty is a procedure with long-term successful outcomes. However, there are several potential complications including retained cement fragments, bearing dislocation, infection, component loosening, medial collateral ligament injury, and overcorrection, leading to progressive arthritis. Periprosthetic fracture is an uncommon complication, with multiple reports showing an incidence of less than 1%. Hence, there are no established algorithms to guide treatment. A consecutive series of 2,464 patients who underwent partial knee arthroplasty between January 2009 and April 2017 was reviewed...
October 3, 2018: Journal of Knee Surgery
Jean-Thomas Leclerc, Laëtitia Michou, François Vaillancourt, Stéphane Pelet, David Simonyan, Etienne L Belzile
Bisphosphonate use has been associated with atypical femoral fractures (AFFs), defined by the American Society of Bone and Mineral Research (ASBMR) Task Force criteria, which currently exclude periprosthetic fractures. The objectives of this study were to establish the prevalence of atypical periprosthetic femoral fractures (APFFs) in patients with hip and knee arthroplasties and to determine the clinical and radiological risk factors associated with these fractures. We performed a retrospective radiological review of all femoral fractures between January 1, 2006, and March 31, 2015, in Quebec City, Canada...
October 2, 2018: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
Frank A Liporace, Richard S Yoon
In the elderly, low energy distal femur fractures (native or periprosthetic) can be devastating injuries, carrying high rates of morbidity and mortality, comparable to the hip fracture population. Poor, osteoporotic bone quality facilitates fracture in a vulnerable anatomic region and as a result, operative fixation can be challenging. With goals of early mobilization to reduce subsequent complication risk, employing the nail plate combination (NPC) technique can offer stable, balanced fixation allowing for immediate weight bearing and early mobilization...
September 10, 2018: Journal of Orthopaedic Trauma
Yannick Herry, Anthony Viste, Hugo Bothorel, Romain Desmarchelier, Michel-Henri Fessy
PURPOSE: The purpose of this study was to assess the clinical outcomes, complications, and survival of a long cementless titanium femoral stem in revision total hip arthroplasty (THA) at a minimum five year follow-up. METHODS: Between 2000 and 2010, 114 patients (116 hips), with a mean age of 68 ± 12 years, underwent revision THA using a KAR® stem (DePuy, Leeds, UK). The main reasons for revision were aseptic loosening (82%), periprosthetic joint infections (PJI) (11%), and periprosthetic fractures (6%)...
October 1, 2018: International Orthopaedics
David S Peitgen, Moritz M Innmann, Christian Merle, Tobias Gotterbarm, Babak Moradi, Marcus R Streit
BACKGROUND: Although falling is becoming a major problem in the elderly, little is known about the long-term incidence of postoperative periprosthetic femoral fractures (PFF) after total hip arthroplasty (THA) using uncemented stems with a minimum follow-up of 26 years postoperatively. METHODS: In a consecutive series, the cumulative incidence of PFF after uncemented THA using a straight, collarless, tapered titanium stem was retrospectively reviewed in 354 hips (326 patients)...
September 3, 2018: Journal of Arthroplasty
Russell A Reeves, William W Schairer, David S Jevsevar
INTRODUCTION: Periprosthetic hip fractures (PPFX) are serious complications that result in increased morbidity, mortality and healthcare costs. Decreasing hospital readmissions has been a recent healthcare focus, but little is known about the overall costs associated with PPFX or the risk factors associated with readmissions. We investigated patient demographics, treatment types, 30- and 90-day readmission rates, direct costs, and patient risk factors associated with PPFX readmission...
October 1, 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Elizabeth A Cody, James R Lachman, Elizabeth B Gausden, James A Nunley, Mark E Easley
BACKGROUND: The effect of bone mineral density (BMD) on outcomes from total ankle arthroplasty (TAA) has not been studied. BMD can be estimated by measuring Hounsfield units (HU) on standard computed tomography (CT), which is frequently performed prior to TAA. We aimed to identify whether tibial and talar HU measured from preoperative CT scans were associated with periprosthetic fracture or revision risk in patients undergoing TAA. METHODS: A prospectively collected database was used to retrospectively screen all patients undergoing primary TAA...
September 29, 2018: Foot & Ankle International
J Včelák, M Macko, R Kubeš, K Němec, M Frydrychová
PURPOSE OF THE STUDY The purpose of the study is a retrospective comparison of results of the two-stage revision total hip arthroplasty using a non-articulating and an articulating spacer to treat periprosthetic joint infection (PJI). Two basic hypotheses are evaluated: (1) the clinical outcomes of the patients treated with "hand made" articulating cement spacer are better than in non-articulating patient's group in two-stage revision for PJI of the total hip arthroplasty and (2) PJI recurrence is higher in the group of patients treated with an articulating spacer group...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Alexander B Christ, Harshvardhan Chawla, Elizabeth B Gausden, Jordan C Villa, David S Wellman, Dean G Lorich, David L Helfet
OBJECTIVES: To report outcomes and complications of periprosthetic distal femur fractures (PPDFF) treated with open reduction internal fixation (ORIF) using a plate construct, with or without endosteal augmentation. DESIGN: Retrospective Case Series. SETTING: One Level I trauma center and one tertiary care hospital. PATIENTS/PARTICIPANTS: Forty patients with PPDFFs, treated by 3 surgeons, were identified using an institutional trauma registry...
October 2018: Journal of Orthopaedic Trauma
Robert S OʼConnell, John R Owen, Erik J Hansen, Azhar S Bashir, Jennifer S Wayne, Jibanananda Satpathy, Stephen L Kates
OBJECTIVES: To evaluate the strength of proximal bicortical fixation using a novel osteoporotic synthetic bone model of Vancouver B1 periprosthetic proximal periprosthetic femur fractures (PFFs) and to assess the influence of strut allograft augmentation with regard to allowing early assisted weight bearing. The secondary aim was to evaluate whether the strut position, either medial or anterior, influenced the strength of the construct. METHODS: Thirty synthetic osteoporotic femurs were implanted with cemented stems...
October 2018: Journal of Orthopaedic Trauma
Young-Kyun Lee, Chan Ho Park, Ki-Choul Kim, Seong Hwa Hong, Yong-Chan Ha, Kyung-Hoi Koo
BACKGROUND: Atypical femoral fracture (AFF) is a serious complication after the use of bisphosphonates, and periprosthetic femoral fracture (PFF) appeared as a common complication after hip arthroplasty, especially in senile patients. Although American Society for Bone and Mineral Research has excluded PFFs from the definition of AFFs, several case reports found PFF patients undergoing bisphosphonate treatment, have fractures resembling AFF and the authors suggested that AFF can also occur in operated femurs after hip arthroplasty...
September 8, 2018: Injury
José A Rodriguez, Zachary P Berliner, Carlos A Williams, Jonathan Robinson, Matthew S Hepinstall, H John Cooper
Introduction: Periprosthetic femoral fractures, which are likely to increase as the population ages and total hip arthroplasty becomes more prevalent1 , can be effectively managed by restoring femoral length via preoperative planning and surgical execution using a cementless, tapered, fluted stem. Indications & Contraindications: <AbstractText Label="Step 1 Preoperative Plan" NlmCategory="UNASSIGNED">Template the contralateral, uninjured side. Step 2 Template the Fractured Side: Identify the ideal COR on the injured side and template the femoral stem...
September 28, 2017: JBJS Essential Surgical Techniques
Goksel Dikmen, Vahit Emre Ozden, Burak Beksac, Ismail Remzi Tozun
PURPOSE: The aim of this study was to assess the long-term performance of tapered one-third proximally coated stems in dysplastic hips. METHODS: This study included 135 dysplasia patients (150 hips) who underwent a total hip arthroplasty and had a minimum follow-up of ten years. Single design tapered stems were used in all patients. There were 112 women (83%) and 23 men (17%) with a mean age of 45 years (23 to 72) at the time of surgery. The mean follow-up was 14...
September 19, 2018: International Orthopaedics
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