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标题：Results after surgical treatment of periprosthetic proximal femoral fractures. Osteosynthesis with prosthesis preservation vs. prosthesis change
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作者：Dirk Zajonz ; Cathleen Pönick ; Melanie Edel 等
期刊名称：GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW
印刷版ISSN：2193-8091
电子版ISSN：2193-8091
出版年度：2020
卷号：9
DOI：10.3205/iprs000146
出版社：German Medical Science
摘要：Background: Periprosthetic fractures (PPF) of the femur close to the hip joint have serious consequences for most geriatric affected patients. In principle, apart from the highly uncommon conservative therapy, there are two therapeutic options. On the one hand, the prosthesis-preserving treatment by means of osteosynthesis using plates and/or cerclages in general is available. On the other hand, a (partial) change of the prosthesis with optionally additive osteosynthesis or a proximal femoral replacement can be performed because of prosthesis loosening or non-reconstructable comminuted fractures as well as most cemented stem variations. The aim of this retrospective study is the analysis of periprosthetic proximal femoral fractures in the presence of a total hip arthroplasty (THA). The outcome of the operated patients is to be investigated depending on the type of care (osteosynthesis with prosthesis preservation vs. prosthesis change). Material and methods: In a retrospective case analysis, 80 patients with THA and PPF were included. They were divided into two groups. Group I represents the osteosynthetic treatment to preserve the implanted THA (n=42). Group II (n=38) includes those patients who were treated by a change of their endoprosthesis with or without additional osteosynthesis. Specifics of all patients, like gender, age at fracture, interval between fracture and implantation, length of in-patient stay, body mass index, osteoporosis, corticomedullary index and complications such as infections, re-fracture, loosening, material failure or other complications, were recorded and compared. Furthermore, the patients were re-examined by a questionnaire and the score according to Merle d’Aubigné and Postel. Results: In group I the mean follow-up time was 48.5±23 months (4 y ears) whereas group II amounted 32.5±24.5 months (2.7 years) (p=0.029). Besides, there were significant differences in age (81± 1 1 y ears vs. 76±10 years, p=0.047) and length of in-patient stay (14.5±8.6 days vs. 18.0±16.7 days, p=0.014). According to the score of Merle d’Aubigné and Postel, there were significantly better values for the pain in group II with comparable values for mobility and walking ability. Conclusion: The treatment of periprosthetic proximal fractures of the femur is dependent on the classification (Vancouver and Johannsen) and in particular on the prosthetic anchoring as well as the extent of the comminution zone. Older patients and patients with osteoporosis are more frequently treated with an endoprosthesis revision. Patients, who have been treated with an osteosynthesis for preserving their endoprosthesis, showed a shorter length of in-patient stay and fewer complications than people with replacement surgery. In contrast to that, patients with prosthesis revision had better outcomes concerning the score of Merle d’Aubigné and Postel.
关键词：periprosthetic proximal femoral fracture; osteosynthesis; prosthesis change