| 1. |
- Chatziagorou, Georgios, et al.
(författare)
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Incidence and demographics of 1751 surgically treated periprosthetic femoral fractures around a primary hip prosthesis.
- 2019
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Ingår i: Hip international : the journal of clinical and experimental research on hip pathology and therapy. - : SAGE Publications. - 1724-6067. ; 29:3, s. 282-288
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Tidskriftsartikel (refereegranskat)abstract
- Periprosthetic femoral fractures (PPFF), treated surgically, have been recorded in the Swedish Hip Arthroplasty Register (SHAR) since 1979. It is postulated that fractures treated with other methods other than stem revision have a lower registration rate, which may lead to incomplete registry data and thus, inaccurate information. We collected all PPFFs surgically treated in Sweden between 2001 and 2011 with the purpose of studying the annual incidence, demographics and distribution of fracture types with regard to type of fixation.Data was linked between the SHAR and the National Patient Register (NPR) in order to detect even those PPFFs not reported to the SHAR. Fractures were classified according to the Vancouver classification system, based on information collected from the medical charts. This procedure was validated with observer variation analysis compared to fracture classification based on radiographs. In total 1751 first-time PPFFs around primary conventional stems were included.The incidence of PPFF increased from about 1.0 per 1000 primary THRs to 1.4. Vancouver type C fractures (37% of all fractures) were more common than previously reported, and more common in cemented than in uncemented stems. The 3 most common stem designs involved were Exeter polished, Lubinus SPII, and Charnley (66.3% of all stems), partly reflecting their occurrence in the Swedish THR population.The incidence of PPFFs has increased in Sweden during the period 2001 to 2011. The improved reporting of type C fractures, after data-linking, revealed an almost 4 times higher incidence compared to previous register studies in Sweden.
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| 2. |
- Chatziagorou, Georgios, et al.
(författare)
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Lower reoperation rate with locking plates compared with conventional plates in Vancouver type C periprosthetic femoral fractures: A register study of 639 cases in Sweden
- 2019
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Ingår i: Injury. - : Elsevier BV. - 0020-1383 .- 1879-0267. ; 50:12, s. 2292-2300
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate demographics and outcomes of Vancouver type C periprosthetic femoral fractures (PPFF) treated with open reduction and internal fixation. Methods: Patient data were obtained from medical charts of cases reported to the Swedish Hip Arthroplasty Register and/or from the National Patient Register. Vancouver type C fractures undergoing surgery between 2001 and 2011, in patients who had received their primary THR between 1979 and 2011, were included. Any further reoperation performed between 2001 and 2013 and related to the PPFF constituted the primary outcome. Results: A total of 632 patients with 639 Vancouver type C fractures were identified. The majority of the patients were women (84%) and they had a fracture distal to a cemented stem (95%). The mean age at the time of fracture was 72 years. Treatment was performed with a locking plate (363 cases), a conventional plate (184 cases), an intramedullary nail (62 cases), or with double plating (30 cases). The overall reoperation rate was 17%, and mortality within one year of the operation was 16%. Locking plates had a significantly lower reoperation rate than conventional plates (p<0.001) and intramedullary nailing (p = 0.005). Interprosthetic femoral fractures did not have a statistically different outcome compared with non-IPFFs. Conclusions: The lowest reoperation rate was observed using locking plates in Vancouver type C fractures when compared with conventional plates or intramedullary nailing. The presence of an ipsilateral knee prosthesis did not influence the outcome of the surgical treatment.
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| 3. |
- Chatziagorou, Georgios
(författare)
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Periprosthetic femoral fracture after total hip replacement. Incidence, risk factors, and treatment
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis investigates the incidence of surgically treated periprosthetic femoral fractures (PPFF) in Sweden between 2001 and 2011, the demography of this population, risk factors that may contribute to its occurrence and the treatment of these fractures. All four studies in this thesis are observational and are based primarily on material from the Swedish Hip Arthroplasty Register (SHAR) database. This database was linked with data from the National Patient Register (NPR) in two stages and with the Swedish Knee Arthroplasty Register. Data were extracted from both the SHAR database and medical records. In Paper I, the data link revealed a low registration rate in cases where other treatment methods than femoral stem revision were applied. The incidence of PPFFs increased in Sweden during the study period, with higher incidence in individuals older than 80 years. Paper II showed that the force-closed design of the cemented Exeter stem was a risk factor (HR=9.6) for fractures close to a hip stem (Vancouver type B) when compared with the shape-closed Lubinus SP II cemented stem. Age, gender, diagnosis and calendar year at primary THR also influenced the risk of PPFF. In Paper III. Vancouver type B1 and interprosthetic femoral fractures (IPFF) ran a higher risk of a poor outcome in cases with cemented stem fixation and primary osteoarthritis at the index operation. The type of plate fixation preferred in B1 fractures did not influence the outcome, whereas the choice of ORIF (open reduction and internal fixation) instead of stem revision in B2/B3 fractures resulted in a poorer outcome. Similar re-reoperation rates were recorded for cemented and uncemented modular or monoblock revision stems in the treatment of B2/B3 fractures. Vancouver type C fractures were studied in paper IV. Locking plates had a lower re-reoperation rate within two years of the PPFF, when compared with conventional plates in patients without an ipsilateral knee prosthesis. Within two years of the surgical treatment of a Vancouver type C fracture, 24% of the population had died. The re-reoperation rate for all B and all C fractures was 17.3% and 15.2% respectively (Papers III and IV). In conclusion, periprosthetic fractures treated with methods other than stem revision had a low registration rate in the SHAR. The incidence of this complication increased in 2001-2011. The cemented Exeter stem involved a 10 times higher risk of Vancouver type B fractures than the Lubinus SP II stem. The presence of an ipsilateral knee prosthesis was a risk factor for poorer outcome in type B but not in type C fractures. The type of plate fixation influenced the outcome of type C and not of type B1 fractures.
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| 4. |
- Chatziagorou, Georgios, et al.
(författare)
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Surgical treatment of Vancouver type B periprosthetic femoral fractures PATIENT CHARACTERISTICS AND OUTCOMES OF 1381 FRACTURES TREATED IN SWEDEN BETWEEN 2001 AND 2011
- 2019
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Ingår i: Bone & Joint Journal. - 2049-4394. ; 101B:11, s. 1447-1458
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Tidskriftsartikel (refereegranskat)abstract
- Aims We investigated patient characteristics and outcomes of Vancouver type B periprosthetic fractures treated with femoral component revision and/or osteosynthesis. Patients and Methods The study utilized data from the Swedish Hip Arthroplasty Register (SHAR) and information from patient records. We included all primary total hip arthroplasties (THAs) performed in Sweden since 1979, and undergoing further surgery due to Vancouver type B periprosthetic femoral fracture between 2001 and 2011. The primary outcome measure was any further reoperation between 2001 and 2013. Cross-referencing with the National Patient Register was performed in two stages, in order to identify all surgical procedures not recorded on the SHAR. Results Out of 1381 Vancouver type B fractures that fulfilled the inclusion criteria, 257 underwent further reoperation by the end of 2013. Interprosthetic and Type B1 fractures had a higher risk for reoperation. For B1 fractures, the rate of reoperation did not differ (p = 0.322) after use of conventional (26%) or locking plate osteosynthesis (19%). No significant differences were observed between cemented, cementless monoblock, and cementless modular revision components for the treatment of type B2 and B3 fractures. Conclusion In this country-specific study, the choice of locking or conventional plates for the treatment of type B1, and cemented or cementless femoral components fixation for B2 and B3 fractures, had no significant influence on risk for reoperation. Interprosthetic fractures adversely affected the outcome of treatment of type B fractures. Differences in the patient characteristics of the compared groups were observed.
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| 5. |
- Chatziagorou, Georgios, et al.
(författare)
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The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems.
- 2019
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Ingår i: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 90:2, s. 135-142
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - In total hip replacements, stem design may affect the occurrence of periprosthetic femoral fracture. We studied risk factors for fractures around and distal to the 2 most used cemented femoral stems in Sweden. Patients and methods - This is a register study including all standard primary Lubinus SPII and Exeter Polished stems operated in Sweden between 2001 and 2009. The outcome was any kind of reoperation due to fracture around (Vancouver type B) or distal to the stem (Vancouver type C), with use of age, sex, diagnosis at primary THR, and year of index operation as covariates in a Cox regression analysis. A separate analysis of the primary osteoarthritis patient group was done in order to evaluate eventual influence of the surgical approach (lateral versus posterior) on the risk for Vancouver type B fractures. Results - The Exeter stem had a 10-times (95% CI 7-13) higher risk for type B fractures, compared with the Lubinus, while no statistically significant difference was noticed for type C fractures. The elderly, and patients with hip fracture or idiopathic femoral head necrosis, had a higher risk for both fracture types. Inflammatory arthritis was a risk factor only for type C fractures. Type B fractures were more common in men, and type C in women. A lateral approach was associated with decreased risk for Type B fracture. Interpretation - Stem design influenced the risk for type B, but not for type C fracture. The influence of surgical approach on the risk for periprosthetic femoral fracture should be studied further.
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| 7. |
- Sattar, Ali, et al.
(författare)
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Fracture pattern and risk factors for reoperation after treatment of 156 periprosthetic fractures around an anatomic cemented hip stem
- 2023
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Ingår i: Acta Orthopaedica. - 1745-3674 .- 1745-3682. ; 94, s. 438-446
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — The Lubinus SP2 stem has been associated with a very low risk of periprosthetic femoral fractures (PPFFs). We aimed, primarily, to study the radiographic morphology of PPFFs close to a Lubinus SP2 stem. Secondarily, we analyzed whether higher reoperation rate was correlated to the revision method chosen or to the characteristics of the fracture and of the bone. Patients and methods — The study included 156 femoral fractures close to a Lubinus cemented stem. These fractures were treated in 40 hospitals in Sweden between 2006 and 2011 and were followed up until 2019. Data from the Swedish Arthroplasty Register was used. Medical records and radio-graphs were studied. The fractures were classified accord-ing to the Vancouver classification. The fracture location and anatomy were delineated. We also measured the remaining attachment index (RAI) and the canal thickness ratio. Results — Vancouver type C (n = 101) and spiral fractures (n = 67, 41 in Vancouver C and 26 in Vancouver B) were the most common fracture types. 4 fractures were avul-sion of the greater trochanter. The remaining 51 fractures occurred around the stem (B1: 25, B2: 16, and B3: 10). B fractures were more commonly reoperated on (18 of 51, 35%) than type C fractures (11 of 101, 11%, P = 0.001). In most femurs with type B3 fracture, the fracture line covered an area only around the stem, but in all B1 and in 11 of 16 B2 fractures, it was extended even distal to the stem. ORIF instead of stem revision in B2 fractures, use of short stems or plates, and inadequate reduction of the fractures were risk factors for subsequent reoperations. Conclusion — The higher reoperation rate in type B fractures, compared with fractures distal to the stem, could be caused by their higher degree of complexity and reduced capacity for healing in the region around the stem.
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