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Multicenter Study
. 2022 Feb;53(2):645-652.
doi: 10.1016/j.injury.2021.11.047. Epub 2021 Nov 23.

Periprosthetic femoral fracture type and location are influenced by the presence of an ipsilateral knee arthroplasty implant: A case-control study of 84 interprosthetic femoral fractures

Oliver Townsend  1 , Sameer Jain  2 , Jonathan N Lamb  2 , Chloe E H Scott  3 , Douglas G Dunlop  4 , Hemant G Pandit  2
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Free article
Multicenter Study

Periprosthetic femoral fracture type and location are influenced by the presence of an ipsilateral knee arthroplasty implant: A case-control study of 84 interprosthetic femoral fractures

Oliver Townsend et al. Injury. 2022 Feb.
Free article

Abstract

Background: This multicentre case-control study compares Vancouver Classification System (VCS) grade and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) fracture type in interprosthetic femoral fractures (IPFFs) between primary total hip arthroplasty (THA) and ipsilateral total knee arthroplasty (TKA) to periprosthetic femoral fracture (PFF) without ipsilateral TKA.

Methods: Data were collected following institutional approval. Eighty-four IPFFs were assessed for VCS grade and AO/OTA type. Each IPFF case (84) was matched to five PFF controls (360) by age, gender and stem fixation philosophy (SMD<0.1). VCS grade and AO/OTA type were compared between the IPFF and PFF groups using weighted proportions and medians.

Results: Median (IQR) age of IPFF patients was 81.75 (76.57-85.33) years and 61 (72.6%) were female. The commonest VCS grade was B1 (34, 40.5%). The commonest AO/OTA type was spiral (51.8% of VCS B fractures; 50.0% of VCS C fractures). A greater proportion of fractures occurred distal to the stem in IPFF patients versus PFF patients (33.3% versus 18.2%, p = 0.003). VCS grade was significantly different between groups (p = 0.015). For VCS C fractures, twice as many AO/OTA transverse and wedge fractures occurred in the IPFF group compared to the PFF group (25.0% versus 12.6% and 7.1% versus 3.3%, respectively) although the overall difference was not statistically significant (p = 0.407).

Conclusion: The presence of an ipsilateral TKA affects the location of PFF with more fractures occurring distal to the stem. A greater proportion of bending type fractures occurred when an ipsilateral TKA was present. These unstable fractures often require more complex surgery.

Keywords: Femoral fracture; Interprosthetic; Periprosthetic; Total hip arthroplasty; Total knee arthroplasty.

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Conflict of interest statement

Declaration of Competing Interest The work under consideration for pubilcation did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declare the following potential conflicts of interest outside of this piece of work: Sameer Jain – personal fees from Stryker and Pfizer; grants from Stryker; editorial board roles on the BJJ & BJR. Hemant Pandit – personal fees from Zimmer Biomet, DePuy Synthes, Invibio, Smith and Nephew, and JRI Ortho; grants from Zimmer Biomet and DePuy Synthes.

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