The aim of this study was to describe the demographic details of patients who sustain a femoral periprosthetic fracture (PPF), the epidemiology of PPFs, PPF characteristics, and the predictors of PPF types in the UK population. This is a multicentre retrospective cohort study including adult patients presenting to hospital with a new PPF between 1 January 2018 and 31 December 2018. Data collected included: patient characteristics, comorbidities, anticoagulant use, social circumstances, level of mobility, fracture characteristics, Unified Classification System (UCS) type, and details of the original implant. Descriptive analysis by fracture location was performed, and predictors of PPF type were assessed using mixed-effects logistic regression models.Aims
Methods
Aims. Periprosthetic femoral fractures (PFF) following total hip arthroplasty
(THA) are devastating complications that are associated with functional
limitations and increased overall mortality. Although cementless
implants have been associated with an increased risk of PFF, the
precise contribution of implant geometry and design on the risk
of both intra-operative and post-operative PFF remains poorly investigated.
A systematic review was performed to aggregate all of the PFF literature
with specific attention to the femoral implant used. Patients and Methods. A systematic search strategy of several journal databases and
recent proceedings from the American Academy of Orthopaedic Surgeons
was performed. Clinical articles were included for analysis if sufficient
implant description was provided. All articles were reviewed by
two reviewers. A review of fundamental investigations of implant
load-to-failure was performed, with the intent of identifying similar
conclusions from the clinical and fundamental literature. Results. In total 596 articles were initially identified, with 34 being
eligible for analysis. Aggregate analysis of 1691 PFFs in 342 719
primary THAs revealed a significantly higher number of PFFs with
cementless femoral implants (p <
0.001). Single-wedge and double-wedge
(fit-and-fill) femoral implants were associated with a threefold
increase in PFF rates (p <
0.001) compared with anatomical, fully
coated and tapered/rounded stems. Within cemented stems, loaded-taper
(Exeter) stems were associated with more PFFs than composite-beam
(Charnley) stems (p = 0.004). Review of the fundamental literature
revealed very few studies comparing cementless component designs. Conclusion. Very few studies within the PFF literature provide detailed implant
information. Cementless implants, specifically those of single-wedge
and double-wedge, have the highest PFF rates in the literature,
with most investigations recommending against their use in older
patients with osteoporotic bone. This review illustrates the need
for registries and future PFF studies to record implant name and
information for future analysis. Furthermore, future biomechanical
investigations comparing modern implants are needed to clarify the
precise contribution of
Patient engagement in adaptive health behaviours and interactions with their healthcare ecosystem can be measured using self-reported instruments, such as the Patient Activation Measure (PAM-13) and the Effective Consumer Scale (ECS-17). Few studies have investigated the influence of patient engagement on limitations (patient-reported outcome measures (PROMs)) and patient-reported experience measures (PREMs). First, we assessed whether patient engagement (PAM-13, ECS-17) within two to four weeks of an upper limb fracture was associated with limitations (the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and Patient-Reported Outcome Measurement Information System Upper Extremity Physical Function computer adaptive test (PROMIS UE PF) scores) measured six to nine months after fracture, accounting for demographic, clinical, and psychosocial factors. Secondly, we assessed the association between patient engagement and experience (numerical rating scale for satisfaction with care (NRS-C) and satisfaction with services (NRS-S) six to nine months after fracture. A total of 744 adults with an isolated fracture of the proximal humerus, elbow, or distal radius completed PROMs. Due to multicollinearity of patient engagement and psychosocial variables, we generated a single variable combining measures of engagement and psychosocial factors using factor analysis. We then performed multivariable analysis with p < 0.10 on bivariate analysis.Aims
Methods
The aim of this study was to describe implant and patient-reported outcome in patients with a unilateral transfemoral amputation (TFA) treated with a bone-anchored, transcutaneous prosthesis. In this cohort study, all patients with a unilateral TFA treated with the Osseointegrated Prostheses for the Rehabilitation of Amputees (OPRA) implant system in Sahlgrenska University Hospital, Gothenburg, Sweden, between January 1999 and December 2017 were included. The cohort comprised 111 patients (78 male (70%)), with a mean age 45 years (17 to 70). The main reason for amputation was trauma in 75 (68%) and tumours in 23 (21%). Patients answered the Questionnaire for Persons with Transfemoral Amputation (Q-TFA) before treatment and at two, five, seven, ten, and 15 years’ follow-up. A prosthetic activity grade was assigned to each patient at each timepoint. All mechanical complications, defined as fracture, bending, or wear to any part of the implant system resulting in removal or change, were recorded.Aims
Methods
We reviewed all patients who sustained a fracture of the hip
and were treated in Northern Ireland over a period of 15 years to
identify trends in incidence, the demographics of the patients,
the rates of mortality, the configuration of the fracture and the
choice of implant. Since 01 January 2001 data about every fracture of the hip sustained
in an adult have been collected centrally in Northern Ireland. All
adults with such a fracture between 2000 and 2015 were included
in the study. Temporal changes in their demographics, the mode of
treatment, and outcomes including mortality were analysed.Aims
Patients and Methods
Management of bisphosphonate-associated subtrochanteric
fractures remains opinion- or consensus-based. There are limited
data regarding the outcomes of this fracture. We retrospectively reviewed 33 consecutive female patients with
a mean age of 67.5 years (47 to 91) who were treated surgically
between May 2004 and October 2009. The mean follow-up was 21.7 months
(0 to 53). Medical records and radiographs were reviewed to determine
the post-operative ambulatory status, time to clinical and radiological
union and post-fixation complications such as implant failure and
need for second surgery. The predominant fixation method was with an extramedullary device
in 23 patients. 25 (75%) patients were placed on wheelchair mobilisation
or no weight-bearing initially. The mean time to full weight-bearing
was 7.1 months (2.2 to 29.7). The mean time for fracture site pain
to cease was 6.2 months (1.2 to 17.1). The mean time to radiological
union was 10.0 months (2.2 to 27.5). Implant failure was seen in
seven patients (23%, 95 confidence interval (CI) 11.8 to 40.9).
Revision surgery was required in ten patients (33%, 95 CI 19.2 to
51.2). A large proportion of the patients required revision surgery
and suffered implant failure. This fracture is associated with slow
healing and prolonged post-operative immobility. Cite this article:
Our aim in this pilot study was to evaluate the fixation of, the bone remodelling around, and the clinical outcome after surgery of a new, uncemented, fully hydroxyapatite-coated, collared and tapered femoral component, designed specifically for elderly patients with a fracture of the femoral neck. We enrolled 50 patients, of at least 70 years of age, with an acute displaced fracture of the femoral neck in this prospective single-series study. They received a total hip replacement using the new component and were followed up regularly for two years. Fixation was evaluated by radiostereometric analysis and bone remodelling by dual-energy x-ray absorptiometry. Hip function and the health-related quality of life were assessed using the Harris hip score and the EuroQol-5D. Up to six weeks post-operatively there was a mean subsidence of 0.2 mm (−2.1 to +0.5) and a retroversion of a mean of 1.2° (−8.2° to +1.5°). No component migrated after three months. The patients had a continuous loss of peri-prosthetic bone which amounted to a mean of 16% (−49% to +10%) at two years. The mean Harris hip score was 82 (51 to 100) after two years. The two-year results from this pilot study indicate that this new, uncemented femoral component can be used for elderly patients with osteoporotic fractures of the femoral neck.
A total of 118 consecutive patients with a fracture of the distal radius were treated with a volar locking plate; 50 patients had no ulnar styloid fracture, 41 had a basal ulnar styloid fracture, and 27 had a fracture of the tip of the ulnar styloid. There were no significant differences in radiological and clinical results among the three groups. The outcome was good and was independent of the presence of a fracture of the ulnar styloid. A total of five patients (4.2%) had persistent ulnar-sided wrist pain at final follow-up. Nonunion of the ulnar styloid fracture did not necessarily lead to ulnar wrist pain. Patients with persistent ulnar pain had a higher mean initial ulnar variance and increased post-operative loss of ulnar variance. The presence of an associated ulnar styloid fracture of the ulnar styloid does not adversely affect the outcome in patients with a fracture of the distal radius treated by volar plating.
