Characteristics and Risk Factors of UCS Fracture Subtypes in Periprosthetic Fractures Around the Hip

Overview

Journal Bone Jt Open

Date 2023 Sep 1

PMID 37654129

Authors

Ahmed A H H Nasser

Khabab Osman

Govind S Chauhan

Rohan Prakash

Charles Handford

Rajpal S Nandra

Ansar Mahmood

Affiliations

Soon will be listed here.

Abstract

Aims: Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade.

Methods: Using a multicentre collaborative study design, independent of registry data, we identified adults from 29 centres with PPFs around the hip between January 2010 and December 2019. Radiographs were assessed for the Unified Classification System (UCS) grade. Patient and injury characteristics, management, and outcomes were compared between UCS grades. A multinomial logistic regression was performed to estimate relative risk ratios (RRR) of variables on UCS grade.

Results: A total of 1,104 patients were included. The majority were female (57.9%; n = 639), ethnically white (88.5%; n = 977), used mobility aids (67%; n = 743), and had a median age of 82 years (interquartile range (IQR) 74 to 87). A total of 77 (7%) had pain prior to the PPF. The most common UCS grade was B2 (33%; n = 368). UCS type D fractures had the longest length of stay (median 19 days (IQR 11 to 26)), highest readmission to hospital (21%; n = 9), and highest rate of discharge to step-down care (52%; n = 23). Multinomial regression suggests that uncemented femoral stems are associated with a reduced risk of UCS C (RRR 0.36 (95% confidence interval (CI) 0.2 to 0.7); p = 0.002) and increased risk of UCS A (RRR 3.3 (95% CI 1.9 to 5.7); p < 0.001), compared to UCS B fracture.

Conclusion: The most common PPF type in elderly frail patients is UCS B2. Uncemented stems have a lower risk of UCS C fractures compared to cemented stems. A national PPF database is needed to further identify correlation between implants and fracture subtypes.

References

Vioreanu M, Parry M, Haddad F, Duncan C . Field testing the Unified Classification System for peri-prosthetic fractures of the pelvis and femur around a total hip replacement : an international collaboration. Bone Joint J. 2014; 96-B(11):1472-7. DOI: 10.1302/0301-620X.96B11.34214. View

Karam J, Campbell P, Desai S, Hunter M . Periprosthetic proximal femoral fractures in cemented and uncemented stems according to Vancouver classification: observation of a new fracture pattern. J Orthop Surg Res. 2020; 15(1):100. PMC: 7063746. DOI: 10.1186/s13018-020-01619-4. View

Wu C, Au M, Wu S, Lin L . Risk factors for postoperative femoral fracture in cementless hip arthroplasty. J Formos Med Assoc. 1999; 98(3):190-4. View

Duncan C, Haddad F . The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J. 2014; 96-B(6):713-6. DOI: 10.1302/0301-620X.96B6.34040. View

Bhattacharyya T, Chang D, Meigs J, Estok 2nd D, Malchau H . Mortality after periprosthetic fracture of the femur. J Bone Joint Surg Am. 2007; 89(12):2658-62. DOI: 10.2106/JBJS.F.01538. View

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

Carli A, Negus J, Haddad F . Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture?. Bone Joint J. 2017; 99-B(1 Supple A):50-59. DOI: 10.1302/0301-620X.99B1.BJJ-2016-0220.R1. View

Lindahl H, Garellick G, Regner H, Herberts P, Malchau H . Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am. 2006; 88(6):1215-22. DOI: 10.2106/JBJS.E.00457. View

Boylan M, Riesgo A, Paulino C, Slover J, Zuckerman J, Egol K . Mortality Following Periprosthetic Proximal Femoral Fractures Versus Native Hip Fractures. J Bone Joint Surg Am. 2018; 100(7):578-585. DOI: 10.2106/JBJS.17.00539. View

10.

Mehran N, North T, Laker M . Failure of a modular hip implant at the stem-sleeve interface. Orthopedics. 2013; 36(7):e978-81. DOI: 10.3928/01477447-20130624-33. View

11.

Pivec R, Issa K, Kapadia B, Cherian J, Maheshwari A, Bonutti P . Incidence and Future Projections of Periprosthetic Femoral Fracture Following Primary Total Hip Arthroplasty: An Analysis of International Registry Data. J Long Term Eff Med Implants. 2016; 25(4):269-75. DOI: 10.1615/jlongtermeffmedimplants.2015012625. View

12.

Panichkul P, Bavonratanavech S, Arirachakaran A, Kongtharvonskul J . Comparative outcomes between collared versus collarless and short versus long stem of direct anterior approach total hip arthroplasty: a systematic review and indirect meta-analysis. Eur J Orthop Surg Traumatol. 2019; 29(8):1693-1704. DOI: 10.1007/s00590-019-02516-1. View

13.

Tsiridis E, Haddad F, Gie G . The management of periprosthetic femoral fractures around hip replacements. Injury. 2003; 34(2):95-105. DOI: 10.1016/s0020-1383(02)00257-7. View

14.

. Management and outcomes of femoral periprosthetic fractures at the hip : data from the characteristics, outcomes and management of periprosthetic fracture service evaluation (COMPOSE) cohort study. Bone Joint J. 2022; 104-B(8):997-1008. DOI: 10.1302/0301-620X.104B8.BJJ-2021-1682.R1. View

15.

Bottle A, Griffiths R, White S, Wynn-Jones H, Aylin P, Moppett I . Periprosthetic fractures: the next fragility fracture epidemic? A national observational study. BMJ Open. 2020; 10(12):e042371. PMC: 7733197. DOI: 10.1136/bmjopen-2020-042371. View

16.

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

17.

Thien T, Chatziagorou G, Garellick G, Furnes O, Havelin L, Makela K . Periprosthetic femoral fracture within two years after total hip replacement: analysis of 437,629 operations in the nordic arthroplasty register association database. J Bone Joint Surg Am. 2014; 96(19):e167. DOI: 10.2106/JBJS.M.00643. View

18.

Poss R, Ewald F, Thomas W, Sledge C . Complications of total hip-replacement arthorplasty in patients with rheumatoid arthritis. J Bone Joint Surg Am. 1976; 58(8):1130-3. View

19.

Jones A, Williams T, Paringe V, White S . The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study. Injury. 2015; 47(2):428-31. DOI: 10.1016/j.injury.2015.11.012. View

20.

Chatziagorou G, Lindahl H, Karrholm J . The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems. Acta Orthop. 2019; 90(2):135-142. PMC: 6461110. DOI: 10.1080/17453674.2019.1574387. View