Characteristics and outcomes of interprosthetic versus periprosthetic femur fractures

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2025-08-07 DOI:10.1016/j.injury.2025.112653

Nigel Blackwood , Doriann M. Alcaide , Jose L. Ayala-Ortiz , Jodie Meeks , Christian Just , Alex Heatherly , Clay A. Spitler , Joseph P. Johnson

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引用次数: 0

Abstract

Objectives

The purpose of this study was to compare demographics, treatments, and outcomes of interprosthetic (IPFFs) and periprosthetic femur fractures (PPFFs). IPFFs were hypothesized to occur in older patients and have higher rates of reoperation, implant failure, and mortality.

Methods

This was a retrospective cohort at a Level 1 trauma center analyzing adults with PPFFs/IPFFs from 2012-2024. Patients with < 30 days follow-up were excluded. Patient characteristics, treatments, and complications were compared between IPFFs and PPFFs.

Results

276 patients with 30 IPFFs and 246 PPFFs were included. IPFFs were older (74y v 69y p=.035), more commonly osteoporotic (33% v 11% p<.001), and more commonly current (17% v 14%) or former smokers (7% v 0% p<.001). IPFFs presented with 29 total hip (THA) and knee (TKA) arthroplasties and one THA and unicompartmental knee arthroplasty. PPFFs presented with 130 fractures around THAs and 116 fractures around TKAs. IPFFs more commonly presented with unstable prostheses (40% v 21% p=.017). Of the seven IPFFs treated with nail-plate hybrid constructs (NPCs), six (86%) were immediately weightbearing as tolerated (WBAT). Of the 23 IPFFs not treated with NPCs, 9 (39%) were immediately WBAT (p=.031). IPFFs had more blood loss (811mL v 513mL p=.016). The mortality rate was 15% in IPFFs and 4% in PPFFs (p=.02). IPFFs had higher rates of implant failure (23% v 7% p=.004) and superficial infection (15% v 4% p=.013). Of the seven IPFFs treated with NPCs, there were no implant failures, while 7/23 (30%) IPFFs treated with other techniques failed (p=.09).

Conclusions

IPFFs were older, more commonly osteoporotic, more likely to be smokers, and more often had unstable prostheses at presentation than PPFFs. While treatments were similar, the rate of mortality, implant failure and superficial infection was higher in IPFFs. NPCs may allow for earlier weightbearing but their long-term effects regarding outcomes and stability require further investigation in prospective studies.

Level of evidence

III

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股骨假体间与假体周围骨折的特点和预后

目的本研究的目的是比较假体间（IPFFs）和假体周围股骨骨折（PPFFs）的人口统计学、治疗和结局。假设ipff发生在老年患者中，并且有更高的再手术率、植入失败率和死亡率。方法回顾性分析某一级创伤中心2012-2024年发生PPFFs/IPFFs的成人患者。患者<；排除30天随访。比较IPFFs和PPFFs的患者特征、治疗方法和并发症。结果共纳入276例ipff患者30例，ppff患者246例。ipff患者年龄较大（74岁vs 69岁p= 0.035），骨质疏松症患者较多（33% vs 11% p= 0.001），当前吸烟者较多（17% vs 14%）或既往吸烟者较多（7% vs 0% p= 0.001）。ipff包括29例全髋关节（THA）和膝关节（TKA）置换术，1例全髋关节和单腔膝关节置换术。ppff中tha周围有130处骨折，tka周围有116处骨折。ipff更常见于不稳定假体（40% vs 21% p= 0.017）。在用钉板杂交结构（npc）治疗的7例ipff中，6例（86%）立即耐受负重（WBAT）。在未使用npc治疗的23例ipff中，9例（39%）立即出现WBAT （p= 0.031）。ipff患者失血量较多（811mL vs 513mL p= 0.016）。ipff的死亡率为15%，ppff的死亡率为4% （p= 0.02）。IPFFs有较高的种植失败率（23% vs 7% p= 0.004）和表面感染率（15% vs 4% p= 0.013）。在使用npc治疗的7名IPFFs中，没有植入失败，而使用其他技术治疗的7/23 (30%)IPFFs失败（p= 0.09）。结论与ppff患者相比，sipff患者年龄更大，骨质疏松症更常见，吸烟的可能性更大，就诊时假体更不稳定。虽然治疗方法相似，但ipff的死亡率、种植体失败率和表面感染率更高。npc可能允许早期负重，但其对结果和稳定性的长期影响需要在前瞻性研究中进一步调查。证据水平ii

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来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.