Femoral Offset Restoration Affects the Early Outcome of Revision in Patients with Periprosthetic Femoral Fractures of Vancouver B2 - a Single-center Retrospective Cohort Study

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2023 Jul 11

PMID 37434207

Authors

Lei Sun

Wenjing Song

Zhongyuan Zhang

Ziyao Xu

Mengshuai Sun

Guangling Gao

Hongjiang Jiang

Changjun Ju

Affiliations

Soon will be listed here.

Abstract

Background: Femoral offset (FO) restoration plays an important role in improving the prognosis and quality of life of patients undergoing hip replacement. However, it is not given enough attention in revisions among patients with periprosthetic femoral fractures (PPFFs); instead, more attention is given to reduction, fixation of fractures and stabilizing prostheses. The primary objective of this study was to evaluate the effect of FO restoration on the function of the hip joint in revisions of patients with PPFF of Vancouver B2. Moreover, we studied whether there is a difference in FO restoration between modular and nonmodular stems.

Methods: A retrospective review of 20 patients with PPFF of Vancouver B2 revised with a tapered fluted modular titanium stem and 22 patients with PPFF of Vancouver B2 revised with a tapered fluted nonmodular titanium stem from 2016 to 2021 was conducted. Based on the difference between the FO of the affected side and that of the healthy side, 26 patients were allocated into Group A (difference ≤ 4 mm), and 16 patients were allocated into Group B (difference > 4 mm). The postoperative Harris Hip Score (HHS), range of motion of the hip joint, length of both lower limbs and dislocation were compared between Group A and Group B. The proportions of patients with FO restoration (difference ≤ 4 mm) and stem subsidence were compared between the modular and nonmodular groups.

Results: The mean follow-up time was 34.3 ± 17.3 months, and all cases achieved fracture healing at the last visit. Patients in Group A had a higher HHS, larger range of abduction, fewer dislocations and less limb length discrepancy (LLD). Patients in the modular group had a higher proportion of FO restoration and less subsidence.

Conclusion: FO restoration improves postoperative hip joint function and reduces dislocation and LLD in revisions of patients with PPFF of Vancouver B2. Compared with nonmodular prostheses, modular prostheses tend to be easier for FO restoration under complex circumstances.

Citing Articles

Mid-term results of a cementless hip stem in femoral revision: how much diaphyseal press-fit do we need?.

Herold D, Kuttner A, Dreyer L, Eingartner C Arch Orthop Trauma Surg. 2024; 144(4):1813-1820.

PMID: 38217640 PMC: 10965576. DOI: 10.1007/s00402-023-05191-4.

References

Mahmood S, Mukka S, Crnalic S, Wretenberg P, Sayed-Noor A . Association between changes in global femoral offset after total hip arthroplasty and function, quality of life, and abductor muscle strength. A prospective cohort study of 222 patients. Acta Orthop. 2015; 87(1):36-41. PMC: 4940589. DOI: 10.3109/17453674.2015.1091955. View

White T, Dougall T . Arthroplasty of the hip. Leg length is not important. J Bone Joint Surg Br. 2002; 84(3):335-8. DOI: 10.1302/0301-620x.84b3.12460. View

Bourne R, Rorabeck C . Soft tissue balancing: the hip. J Arthroplasty. 2002; 17(4 Suppl 1):17-22. DOI: 10.1054/arth.2002.33263. View

Conn K, Clarke M, Hallett J . A simple guide to determine the magnification of radiographs and to improve the accuracy of preoperative templating. J Bone Joint Surg Br. 2002; 84(2):269-72. DOI: 10.1302/0301-620x.84b2.12599. View

N Bolink S, Lenguerrand E, Brunton L, Hinds N, Wylde V, Heyligers I . The association of leg length and offset reconstruction after total hip arthroplasty with clinical outcomes. Clin Biomech (Bristol). 2019; 68:89-95. DOI: 10.1016/j.clinbiomech.2019.05.015. View

Rudiger H, Guillemin M, Latypova A, Terrier A . Effect of changes of femoral offset on abductor and joint reaction forces in total hip arthroplasty. Arch Orthop Trauma Surg. 2017; 137(11):1579-1585. DOI: 10.1007/s00402-017-2788-6. View

Park M, Lim Y, Chung W, Ham D, Lee S . Management of periprosthetic femur fractures treated with distal fixation using a modular femoral stem using an anterolateral approach. J Arthroplasty. 2009; 24(8):1270-6. DOI: 10.1016/j.arth.2009.07.013. View

Liebs T, Nasser L, Herzberg W, Ruther W, Hassenpflug J . The influence of femoral offset on health-related quality of life after total hip replacement. Bone Joint J. 2014; 96-B(1):36-42. DOI: 10.1302/0301-620X.96B1.31530. View

Park Y, Moon Y, Lim S . Revision total hip arthroplasty using a fluted and tapered modular distal fixation stem with and without extended trochanteric osteotomy. J Arthroplasty. 2007; 22(7):993-9. DOI: 10.1016/j.arth.2007.03.017. View

10.

McInnis D, Horne G, Devane P . Femoral revision with a fluted, tapered, modular stem seventy patients followed for a mean of 3.9 years. J Arthroplasty. 2006; 21(3):372-80. DOI: 10.1016/j.arth.2005.08.022. View

11.

Rodriguez J, Deshmukh A, Robinson J, Cornell C, Rasquinha V, Ranawat A . Reproducible fixation with a tapered, fluted, modular, titanium stem in revision hip arthroplasty at 8-15 years follow-up. J Arthroplasty. 2014; 29(9 Suppl):214-8. DOI: 10.1016/j.arth.2013.12.035. View

12.

Warrener A . Hominin Hip Biomechanics: Changing Perspectives. Anat Rec (Hoboken). 2017; 300(5):932-945. DOI: 10.1002/ar.23558. View

13.

Zheng H, Gu H, Shao H, Huang Y, Yang D, Tang H . Treatment and outcomes of Vancouver type B periprosthetic femoral fractures. Bone Joint J. 2020; 102-B(3):293-300. DOI: 10.1302/0301-620X.102B3.BJJ-2019-0935.R1. View

14.

Asayama I, Chamnongkich S, Simpson K, Kinsey T, Mahoney O . Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty. J Arthroplasty. 2005; 20(4):414-20. DOI: 10.1016/j.arth.2004.01.016. View

15.

Munro J, Masri B, Garbuz D, Duncan C . Tapered fluted modular titanium stems in the management of Vancouver B2 and B3 peri-prosthetic fractures. Bone Joint J. 2013; 95-B(11 Suppl A):17-20. DOI: 10.1302/0301-620X.95B11.32898. View

16.

Jolles B, Zangger P, Leyvraz P . Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis. J Arthroplasty. 2002; 17(3):282-8. DOI: 10.1054/arth.2002.30286. View

17.

Lecerf G, Fessy M, Philippot R, Massin P, Giraud F, Flecher X . Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res. 2009; 95(3):210-9. DOI: 10.1016/j.otsr.2009.03.010. View

18.

Garbuz D, Masri B, Duncan C . Periprosthetic fractures of the femur: principles of prevention and management. Instr Course Lect. 1998; 47:237-42. View

19.

Sakalkale D, Sharkey P, Eng K, Hozack W, Rothman R . Effect of femoral component offset on polyethylene wear in total hip arthroplasty. Clin Orthop Relat Res. 2001; (388):125-34. DOI: 10.1097/00003086-200107000-00019. View

20.

Duncan C, Masri B . Fractures of the femur after hip replacement. Instr Course Lect. 1995; 44:293-304. View