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Uncemented femoral stem design might have an impact on postoperative periprosthetic femur fracture pattern. A Comparison between flat-wedge and dual-wedge stems

  • Hsuan-Hsiao Ma
    Affiliations
    Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Te-Feng Arthur Chou
    Affiliations
    Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Shang-Wen Tsai
    Correspondence
    Corresponding author. Shang-Wen Tsai, MD, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taiwan, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.
    Affiliations
    Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Cheng-Fong Chen
    Affiliations
    Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Po-Kuei Wu
    Affiliations
    Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Wei-Ming Chen
    Affiliations
    Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Published:February 17, 2021DOI:https://doi.org/10.1016/j.injury.2021.02.039

      Hightlights

      • In this study, in the flat-wedge group, we observed a higher rate of complex fracture patterns (52.2% versus 8.2%), loosened stems (78.2% versus 60.4%) and a subsequent procedure involving stem revision (69.6% versus 50.0%) was more frequently required.
      • In multivariate logistic regression analysis, type I, flat-wedge stem was the only independent risk factor for a complex fracture pattern (aOR 23.60, 95% CI: 6.54–85.16).
      • In the clinical setting, physicians might anticipate periprosthetic fractures that occurred in type 1 stems to have a more complex fracture pattern and revision surgery, which ultimately results in increased overall stress to the patient.

      Abstract

      Introduction

      Type I, flat-wedge and type II, dual-wedge stems are currently two common stem types used in primary, uncemented hip arthroplasty. The prevalence of periprosthetic femur fracture is higher in type I stems, possibly because of the different shapes and areas of bone contact. We aimed to compare the fracture pattern, stem stability during the fracture and type of subsequent procedures in periprosthetic femur fractures between type I and II stems.

      Materials and Methods

      This was a retrospective, cross-sectional study conducted in a single tertiary referral hospital of Taipei, Taiwan. We included primary hip arthroplasty procedures using type I or type II stems complicated with postoperative periprosthetic femur fractures. We recorded the age, sex, ASA grade, index procedure, institution of where the index procedure was performed, trauma mechanism, time from index procedure to fracture, procedure for periprosthetic fracture and radiographic parameters including Dorr type, Vancouver classification, stem stability, fracture pattern, type and brand of the stems for analysis.

      Results

      We included 132 patients who had undergone surgery for periprosthetic femur fracture for type I (N = 46) or type II (N = 86) stems. The mean age was 74.5 years and 52.3% of the patients were female. Type I stems were associated with a higher proportion of a complex fracture pattern (52.2% vs. 8.2%), femoral stem loosening (78.2% vs. 60.4%) and a higher rate of revision stem procedures (69.6% vs. 50.0%) compared with type II stems. Using multivariate analysis, type I stem was the only factor for a complex fracture pattern in the overall population (aOR: 23.60, 95% CI: 6.54–85.16), hemiarthroplasty (aOR: 160.50, 95% CI: 9.77–2635.95) and total hip arthroplasty (aOR: 14.17, 95% CI: 2.92–68.79) subgroups.

      Conclusion

      We observed a difference in fracture patterns between type I and type II stems. Type I stems appear to be an independent risk factor for a complex fracture pattern in patients who had undergone primary hip arthroplasty.

      Keywords

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