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7 pages, 5977 KiB

Open AccessArticle

Metallic versus Non-Metallic Cerclage Cables System in Periprosthetic Hip Fracture Treatment: Single-Institution Experience at a Minimum 1-Year Follow-Up

by Attilio Speranza, Carlo Massafra, Stefano Pecchia, Riccardo Di Niccolo, Raffaele Iorio and Andrea Ferretti

J. Clin. Med. 2022, 11(6), 1608; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11061608 - 14 Mar 2022

Cited by 6 | Viewed by 2734

Abstract

Metallic cerclage cables are reliable and cost-effective internal fixation devices, which are largely used in surgical practice for the treatment of periprosthetic fractures. Nevertheless, complications connected with their use have been described in the literature, including the following: third-body generation, failure and consequent [...] Read more.

Metallic cerclage cables are reliable and cost-effective internal fixation devices, which are largely used in surgical practice for the treatment of periprosthetic fractures. Nevertheless, complications connected with their use have been described in the literature, including the following: third-body generation, failure and consequent migration, fraying, allergies, and injury to the surgical team. The development of new materials offers alternatives to traditional metallic cables. This study compares the outcomes between two groups of patients affected by periprosthetic hip fractures, treated with titanium cables or with ultra-high-molecular-weight polyethylene (UHMWPe) iso-elastic cables. Our retrospective study aims to compare the clinical and radiological outcomes of titanium cables and UHMWPe iso-elastic cables, isolated or associated with dedicated plates, for the surgical treatment of periprosthetic fractures with stable implants. Two groups of 30 (group A—metallic cables) and 24 (group B—UHMWPe iso-elastic cables) patients have been surgically treated in our institution for hip periprosthetic fractures, between September 2017 and June 2020. The mean age of the patients was 81 years in group A and 80 years in group B. In our study, we included fractures classified as B1 or C, according to the Vancouver postoperative fractures classification; the patients were evaluated retrospectively at 1 year postoperatively, regarding the following: surgery time, blood loss, partial weight-bearing time, radiographical healing time, Harris hip score, and postoperative complications. Comparable outcomes were observed in patients from both groups. Group A showed a higher complication rate compared to group B, at 1 year postoperatively. Non-metallic nylon fiber and ultra-high-molecular-weight polyethylene (UHMWPe) cerclage cables could represent a reliable fixation device, ensuring comparable healing and complication rates with traditional titanium cerclage cables. Full article

(This article belongs to the Special Issue Management of Periprosthetic Fractures: Current Experience and Future Developments)

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10 pages, 58332 KiB

Open AccessArticle

LOQTEQ^® VA Periprosthetic Plate—A New Concept for Bicortical Screw Fixation in Periprosthetic Fractures: A Technical Note

by Clemens Kösters, Daniel den Toom, Sven Märdian, Steffen Roßlenbroich, Sebastian Metzlaff, Kiriakos Daniilidis and Jens Everding

J. Clin. Med. 2022, 11(5), 1184; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11051184 - 23 Feb 2022

Viewed by 1464

Abstract

Internal fixation using angle stable plates is the treatment standard in periprosthetic fractures around stable implants. To provide instant postoperative full weight-bearing, bicortical screw fixation is advisable but often surgically demanding. This work presents the first clinical results of the LOQTEQ^® VA [...] Read more.

Internal fixation using angle stable plates is the treatment standard in periprosthetic fractures around stable implants. To provide instant postoperative full weight-bearing, bicortical screw fixation is advisable but often surgically demanding. This work presents the first clinical results of the LOQTEQ^® VA Periprosthetic Plate (aap Implantate AG, Berlin, Germany), a new plate system to simplify screw placement around implants. This plate system uses insertable hinges that allow for variable angle screw anchorage. Data of 26 patients with a mean age of 80 years and a mean follow-up of 13.9 months were retrospectively collected. Patients were clinically and radiologically examined. Bony union was achieved in 14 out of 15 patients with no signs of non-union or implant loosening. One patient, however, presented with implant failure. Clinical scores demonstrated acceptable results. Since the hinge plates are easy to apply, the first results are promising. Full article

(This article belongs to the Special Issue Management of Periprosthetic Fractures: Current Experience and Future Developments)

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11 pages, 960 KiB

Open AccessArticle

A New System for Periprosthetic Fracture Stabilization—A Biomechanical Comparison

by Daniel Rau, Gabriele Rußow, Mark Heyland, Dag Wulsten, Clemens Kösters, Werner Schmölz and Sven Märdian

J. Clin. Med. 2022, 11(3), 892; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030892 - 08 Feb 2022

Cited by 1 | Viewed by 2309

Abstract

In recent years, an increase in periprosthetic femur fractures has become apparent due to the increased number of hip replacements. In the case of Vancouver type B1 fractures, locking plate systems offer safe procedures. This study compared the distal lateral femur plate (LOQTEQ [...] Read more.

In recent years, an increase in periprosthetic femur fractures has become apparent due to the increased number of hip replacements. In the case of Vancouver type B1 fractures, locking plate systems offer safe procedures. This study compared the distal lateral femur plate (LOQTEQ^®, aap Implantate AG) with a standard L.I.S.S. LCP^® (DePuy Synthes) regarding their biomechanical properties in fixation of periprosthetic femur fractures after hip arthroplasty. We hypothesized that the new LOQTEQ system has superior stability and durability in comparison. Eighteen artificial left femurs were randomized in two groups (Group A: LOQTEQ^®; Group B: L.I.S.S. LCP^®) and tested until failure. Failure was defined as 10° varus deformity and catastrophic implant failure (loosening, breakage, progressive bending). Axial stiffness, loads of failure, cycles of failure, modes of failure were recorded. The axial stiffness in Group A with 73.4 N/mm (SD +/− 3.0) was significantly higher (p = 0.001) than in Group B (40.7 N/mm (SD +/− 2.8)). Group A resists more cycles than Group B until 10° varus deformity. Catastrophic failure mode was plate breakage in Group A and bending in Group B. In conclusion, LOQTEQ^® provides higher primary stability and tends to have higher durability. Full article

(This article belongs to the Special Issue Management of Periprosthetic Fractures: Current Experience and Future Developments)

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9 pages, 886 KiB

Open AccessArticle

Is Stem Revision Necessary for Vancouver B2 Periprosthetic Hip Fractures? Analysis of Osteosynthesis Results from 39 Cases

by David González-Martín, Sergio González-Casamayor, Mario Herrera-Pérez, Ayron Guerra-Ferraz, Jorge Ojeda-Jiménez and José Luis Pais-Brito

J. Clin. Med. 2021, 10(22), 5288; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10225288 - 14 Nov 2021

Cited by 4 | Viewed by 2603

Abstract

Although stem revision is recommended for Vancouver B2 periprosthetic hip fractures (PPHFs), there has recently been a debate whether, under certain conditions, they could be treated by osteosynthesis alone. This study aimed to describe the medium-term clinical and radiological results of several patients [...] Read more.

Although stem revision is recommended for Vancouver B2 periprosthetic hip fractures (PPHFs), there has recently been a debate whether, under certain conditions, they could be treated by osteosynthesis alone. This study aimed to describe the medium-term clinical and radiological results of several patients with V-B2 fractures treated via osteosynthesis. A retrospective study of patients with V-B2 PPHF treated by osteosynthesis without stem revision, operated on between 2009 and 2019, was performed. The type of arthroplasty, type of stem, ASA, Charlson Comorbidity Index (CCI), medical and implant complications, reoperation rate, first-year mortality, radiological results (consolidation time), and functional results were analyzed. Thirty-nine patients were included. Their average age was 78.82 years. Most of the patients presented ASA ≥ 3 (35/39) and CCI ≥ 5 (32/39). Radiological consolidation was achieved in 93.5% of patients, with an average consolidation time of 92.93 days. The average Parker test score before admission was 5.84 while the current one was 4.92 (5.16 years follow-up). Osteosynthesis without stem revision is a valid surgical alternative in certain types of patients with V-B2 PPHF, depending on previous mobility, fracture pattern (anatomical reconstruction possible), anesthetic risk, comorbidities, and previous hip pain. Full article

(This article belongs to the Special Issue Management of Periprosthetic Fractures: Current Experience and Future Developments)

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11 pages, 3851 KiB

Open AccessArticle

Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation

by Dariusz Grzelecki, Dariusz Marczak, Kamil Kwolek, Piotr Dudek, Marcin Tyrakowski, Łukasz Olewnik, Maria Czubak-Wrzosek and Jacek Kowalczewski

J. Clin. Med. 2021, 10(21), 4926; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10214926 - 25 Oct 2021

Cited by 3 | Viewed by 4629

Abstract

The aim of this study was to evaluate the bone union, complication rate, clinical and functional outcomes of long-stemmed total knee arthroplasty (TKA) in patients with periprosthetic femoral or tibial shaft fractures and in patients with femoral or tibial shaft fractures with coexisting [...] Read more.

The aim of this study was to evaluate the bone union, complication rate, clinical and functional outcomes of long-stemmed total knee arthroplasty (TKA) in patients with periprosthetic femoral or tibial shaft fractures and in patients with femoral or tibial shaft fractures with coexisting advanced knee osteoarthritis (OA). This retrospective study comprised 25 patients who underwent surgery due to tibial or femoral shaft fractures: (1) with coexisting severe knee OA or (2) with a periprosthetic fracture requiring implant exchange. In all cases, fracture stabilization was performed intramedullary with the use of long-stemmed implants without the use of additional fixation material (plates, screws, or cerclage). Bone union was achieved in 22/25 patients (88%). One patient required revision with additional plate stabilization due to non-union, and asymptomatic partial bone union was observed in two cases. The group with periprosthetic fractures demonstrated good clinical (mean 73.1 ± 13.3) and moderate functional (mean 59.2 ± 18.8) outcomes in the Knee Society Scoring system (KSS). In the group with shaft fracture and coexisting OA significantly higher clinical (excellent results, mean 84.1 ± 11; p = 0.03) and functional (good results, mean 76.2 ± 20.6; p = 0.04) results were noted. There were no statistically significant differences in terms of range of motion (ROM) or complication rate between these two groups. One-stage TKA with a long-stemmed implant without the use of additional fixation material is an effective method for the treatment of femoral or tibial shaft fractures in patients who require joint replacement. Despite being technically demanding, the approach yields bone union and moderate to excellent clinical and functional outcomes with a relatively low complication rate. Full article

(This article belongs to the Special Issue Management of Periprosthetic Fractures: Current Experience and Future Developments)

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12 pages, 4327 KiB

Open AccessArticle

Biomechanical Value of a Protective Proximal Humeral Cerclage in Reverse Total Shoulder Arthroplasty

by Philipp A. Michel, J. Christoph Katthagen, Benedikt Schliemann, Sina Wilkens, Andre Frank, Lukas F. Heilmann, Felix Dyrna and Michael J. Raschke

J. Clin. Med. 2021, 10(19), 4600; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10194600 - 06 Oct 2021

Cited by 3 | Viewed by 2309

Abstract

Reverse shoulder arthroplasty (RSA) is a commonly performed salvage procedure for failed proximal humeral fracture fixation. The rate of intraoperative periprosthetic fractures is higher compared to primary RSA. The goal of this study was to investigate the biomechanical value of a protective cerclage [...] Read more.

Reverse shoulder arthroplasty (RSA) is a commonly performed salvage procedure for failed proximal humeral fracture fixation. The rate of intraoperative periprosthetic fractures is higher compared to primary RSA. The goal of this study was to investigate the biomechanical value of a protective cerclage during stem impaction in a revision surgery setting. Twenty-eight fresh-frozen human humeri were used to assess different configurations for steel wire and FiberTape cerclages. A custom-built biomechanical test setup simulated the mallet strikes during the stem impaction process with the Univers Revers prothesis stem. The mallet energy until the occurrence of a first crack was not different between groups. The total energy until progression of the fracture distally to the cerclage was significantly higher in the cerclage groups compared to the native humerus (9.5 J vs. 3.5 J, respectively; p = 0.0125). There was no difference between the steel wire and FiberTape groups (11.4 J vs. 8.6 J, respectively; p = 0.2695). All fractures were located at the concave side of the stem at the metaphyseal calcar region. This study demonstrates that a protective cerclage can successfully delay the occurrence of a fracture during stem impaction in reverse shoulder arthroplasty. A FiberTape cerclage is biomechanically equally efficient compared to a steel wire cerclage. Full article

(This article belongs to the Special Issue Management of Periprosthetic Fractures: Current Experience and Future Developments)

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10 pages, 1359 KiB

Open AccessArticle

Mortality, Risk Factors and Risk Assessment after Periprosthetic Femoral Fractures—A Retrospective Cohort Study

by Thaqif El Khassawna, Gero Knapp, Nadja Scheibler, Deeksha Malhan, Nike Walter, Christoph Biehl, Volker Alt, Christian Heiss and Markus Rupp

J. Clin. Med. 2021, 10(19), 4324; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10194324 - 23 Sep 2021

Cited by 3 | Viewed by 1683

Abstract

Periprosthetic femoral fracture (PFF) is a devastating complication. Here, the authors aimed to determine the influence of the timing of surgery as a risk factor for mortality and poor postoperative outcome in patients suffering from PFF. A retrospective descriptive analysis of patients treated [...] Read more.

Periprosthetic femoral fracture (PFF) is a devastating complication. Here, the authors aimed to determine the influence of the timing of surgery as a risk factor for mortality and poor postoperative outcome in patients suffering from PFF. A retrospective descriptive analysis of patients treated for PFF between January 2010 and March 2018 was performed. In addition to patient and treatment characteristics, we assessed mortality rates and postoperative functional outcome by using the Harris Hip and WOMAC score. One-year mortality after PFF was 10.7%. Delayed surgery after 48 h did not negatively influence mortality after PFF. The postoperative hospital stay did not influence the mortality rate, nor did it correlate with medical scores of comorbidities, general health or functionalities. Cementation of stem correlated negatively with the WOMAC score. Deceased patients had a higher Charlson Comorbidity Index (CCI) score, while American society of Anaesthesiologists (ASA) scores did not show a significant difference. There were no differences between ORIF and revision arthroplasty. In conclusion, delayed surgery after 48 h does not negatively influence mortality after PFF. The CCI seems to be a suitable tool to assess patients’ risk for increased mortality after PFF, while the usually used ASA score is not able to achieve a relevant risk assessment. Full article

(This article belongs to the Special Issue Management of Periprosthetic Fractures: Current Experience and Future Developments)

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Review

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15 pages, 4725 KiB

Open AccessReview

Peri- and Interprosthetic Femoral Fractures—Current Concepts and New Developments for Internal Fixation

by Clemens Kösters, Daniel den Toom, Sebastian Metzlaff, Kiriakos Daniilidis, Linda Barz and Steffen Roßlenbroich

J. Clin. Med. 2022, 11(5), 1371; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11051371 - 02 Mar 2022

Cited by 5 | Viewed by 3191

Abstract

Treatment of peri- and interprosthetic fractures represents a challenge in orthopedic trauma surgery. Multiple factors such as osteoporosis, polymedication and comorbidities impede therapy and the rehabilitation of this difficult fracture entity. This article summarizes current concepts and highlights new developments for the internal [...] Read more.

Treatment of peri- and interprosthetic fractures represents a challenge in orthopedic trauma surgery. Multiple factors such as osteoporosis, polymedication and comorbidities impede therapy and the rehabilitation of this difficult fracture entity. This article summarizes current concepts and highlights new developments for the internal fixation of periprosthetic fractures. Since the elderly are unable to follow partial weight bearing, stable solutions are required. Therefore, a high primary stability is necessary. Numerous options, such as new angular stable plate systems with additional options for variable angle screw positioning, already exist and are in the process of being further improved. Lately, individually produced custom-made implants are offering interesting alternatives to treat periprosthetic fractures. Full article

(This article belongs to the Special Issue Management of Periprosthetic Fractures: Current Experience and Future Developments)

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