To examine patient mortality, implant survivorship, and complication profiles of proximal femoral replacement (PFR) as compared to revision total hip arthroplasty (REV) or open reduction internal fixation (ORIF) in the treatment of acute periprosthetic fractures of the proximal femur. We performed a retrospective controlled chart review at our tertiary center from from 2000–2010, identifying 97 consecutive acute periprosthetic proximal femoral fractures. Patients were stratified into three treatment groups: PFR (n=21), REV (n=19), and ORIF (n=57). Primary outcome measures included death, implant failure, and reoperation. We also recorded patient demographics, medical comorbidities, fracture type, treatment duration, time to treatment, and complication profiles. Statistical analyis included competing risks survival, which allows independent survival analysis of competing failure mechanisms such as death and implant failure.Objectives
Methods
Patients with above knee amputation face many challenges to mobility including difficulty with socket fit and fatigue due to high energy consumption. The aim of the Endo - Exo-Femur Prosthesis is to avoid problems at the interface between the sleeve of the socket-prosthesis and the soft tissue coat of the femur stump which often impedes an inconspicuous and harmonic gait. In 1999 we began using a transcutaneous, press-fit distal femoral intramedullary device whose most distal external aspect serves as a hard point for AKA prosthesis attachment. The bone guided prosthesis enables an advanced gait via osseoperception and leads to a decreased oxygen consumption of the patient. 43 patients were implanted between 1999 and 2009. Four of the 43 required removal:one for intramedullary infection, one due to stem fracture (replaced), and the two for soft tissue infection. The remaining 39 original prostheses remained. Two pertrochanteric fractures occurred, treated with ORIF. Two bilateral procedures were performed. Initially, twenty patients had chronic soft tissue irritation requiring debridement. This completely resolved by changing the connecting components to a highly polished cobalt chrome. All patients reported increased comfort when compared to socket use. The following additional advantages were observed: improved mobility and endurance, improved proprioception, decreased time required for prosthetic donning, lack of concern regarding changing body weight, and the absence of skin irritation. All patients reported an improvement in sense of position and tactile sensation, leading to an improved gait pattern. Subjectively, the EEFP represents a significant improvement in terms of comfort. Since the introduction of high-gloss polished surfaces, soft tissue irritation is largely eliminated. Intramedullary infection has been negligible, as osseointegration seals the medullary cavity. In summary, the EEFP appears to be an attractive option in transfemoral amputees.
