Optimizing periprosthetic fracture management and in-hospital outcome: insights from the PIPPAS multicentric study of 1387 cases in Spain

被引：5

作者：

Aguado, Hector J. ^{[1
]}

Castillon-Bernal, Pablo ^{[2
]}

Teixidor-Serra, Jordi ^{[3
]}

Garcia-Sanchez, Yaiza ^{[3
]}

Munoz-Vives, Josep M. ^{[4
]}

Camacho-Carrasco, Pilar ^{[5
]}

Jornet-Gibert, Montsant ^{[5
]}

Ojeda-Thies, Cristina ^{[6
]}

Garcia-Portabella, Pablo ^{[7
]}

Pereda-Manso, Adela ^{[1
]}

Mateos-Alvarez, Elvira ^{[1
]}

Manzano-Mozo, Javier ^{[1
]}

Carrillo-Gomez, Raquel ^{[1
]}

Pais-Ortega, Sergio ^{[1
]}

Garcia-Virto, Virginia ^{[1
]}

Noriega-Gonzalez, David ^{[1
]}

Alvarez-Ramos, Begona Aranzazu ^{[1
]}

Ganso-Perez, Abel ^{[1
]}

Cervera-Diaz, Carmen ^{[1
]}

Plata-Garcia, Maria ^{[1
]}

Ortega-Briones, Alina ^{[1
]}

Berrocal-Cuadrado, Juan ^{[1
]}

del Rey-Machimbarrena, Diego Criado ^{[1
]}

Salvador, Jordi ^{[2
]}

Rey, Laura ^{[2
]}

Tomas-Hernandez, Jordi ^{[3
]}

Selga-Marsa, Jordi ^{[3
]}

Andres-Peiro, Jose Vicente ^{[3
]}

Querolt-Coll, Jordi ^{[4
]}

Triana, Guillermo ^{[4
]}

Vives-Barquiel, Marian ^{[5
]}

Renau-Cerrillo, Marina ^{[5
]}

Campuzano-Bitterling, Borja ^{[5
]}

Hernandez, Jose M. ^{[5
]}

Ostilla, Ricardo ^{[5
]}

Carreras-Castaner, Anna ^{[5
]}

Torner, Pere ^{[5
]}

Diaz-Suarez, Rebeca ^{[6
]}

Fernandez, Eliam Ajuria ^{[6
]}

Olaya-Gonzalez, Carlos ^{[6
]}

Fernandez-Villan, Maria ^{[7
]}

De Cortazar, Unai Gracia ^{[1
]}

Arrieta, Mirentxu ^{[8
]}

Escobar, Daniel ^{[8
]}

Castrillo, Estibaliz ^{[8
]}

Balvis, Patricia ^{[9
]}

Arenas, Monica Rodriguez ^{[9
]}

Perez, Angela Garcia ^{[10
]}

Moreta, Jesus ^{[10
]}

Bidea, Inigo ^{[10
]}

机构：

[1] Hosp Clin Univ Valladolid, Serv Traumatol, Ave Ramon & Cajal 3, Valladolid 47003, Spain

[2] Hosp Univ Mutua Terrassa, Trauma Dept, Barcelona, Spain

[3] Hosp Univ Vall Hebron, Taruma Dept, Barcelona 08035, Spain

[4] Hosp Fundacio Althaia de Manresa, Trauma Dept, Manresa, Barcelona, Spain

[5] Hosp Clin Barcelona, Trauma Dept, Barcelona, Spain

[6] Hosp Univ 12 Octubre, Trauma Dept, Madrid, Spain

[7] Hosp Jove, Trauma Dept, Gijon, Spain

[8] Hosp Univ Basurto, Trauma Dept, Bizkaia, Spain

[9] Hosp Alvaro Cunqueiro, Trauma Dept, Pontevedra, Spain

[10] Hosp Univ Galdakao Usansolo, Trauma Dept, Bizkaia, Spain

[11] Hosp Univ Canarias, Trauma Dept, Tenerife, Spain

[12] Hosp Infanta Elena de Valdemor, Madrid, Spain

[13] Hosp Univ Dr Peset de Valencia, Trauma DDept, Valencia, Spain

[14] Hosp Royo Villanova, Dept Gastroenterol, Zaragoza, Spain

[15] Hosp Univ Cabuenes, Trauma Dept, Gijon, Spain

[16] Hosp Clin San Carlos, Trauma Dept, Madrid 28040, Spain

[17] Complejo Hosp Univ Coruna, Trauma Dept, La Coruna, Spain

[18] Hosp Gen Univ Gregorio Maranon, Trauma Dept, Madrid, Spain

[19] Hosp Univ Alava, Trauma Dept, Vitoria, Spain

[20] Hosp Gen Univ Arcos Mar Menor, Murcia, Spain

[21] Hosp Vega Baja de Orihuela, Dept Cardiol, Alicante, Spain

[22] Hosp Gen Univ JM Morales Meseguer, Serv Anat Patol, Murcia, Spain

[23] Hosp Univ Marques Valdecilla, Trauma Dept, Santander, Spain

[24] Hosp Univ Toledo, Trauma Dept, Toledo, Spain

[25] Hosp Puerta de Hierro Majadahonda, Trauma Dept, Madrid, Spain

[26] Complejo Asistencial Segovia, Serv Nefrol, Segovia, Spain

[27] Consorci Sanitari Integral Hosp St Joan Despi Mois, Trauma Dept, Barcelona, Spain

[28] Hosp Univ Sagrat Cor Quironsalud, Trauma Dept, Barcelona, Spain

[29] Complejo Hosp Llerena Zafra, Trauma Dept, Zafra, Badajoz, Spain

[30] Hosp Univ Lucus Augusti, Cardiol Dept, Lugo, Spain

[31] Hosp Ramon & Cajal, Trauma Dept, Madrid, Spain

[32] Hosp Principe Asturias, Trauma Dept, Alcala De Henares, Spain

[33] Hosp Gen Univ Reina Sofia, Trauma Dept, Murcia, Spain

[34] Hosp Gen Obispo Polanco, Trauma Dept, Teruel, Spain

[35] Hosp Univ Guadalajara, Trauma Dept, Guadalajara, Spain

[36] Hosp Univ Doctor Josep Trueta, Trauma Dept, Girona, Spain

[37] Complejo Hosp Univ Albacete, Trauma Dept, Albacete, Spain

[38] Hosp Sierrallana de Torrelavega, Trauma Dept, Torrelavega, Cantabria, Spain

[39] Complejo Asistencial Univ Palencia, Dept Microbiol, Palencia, Spain

[40] Complexo Hosp Univ Pontevedra, Trauma Dept, Pontevedra, Spain

[41] Hosp Univ Parc Tauli de Sabadell, Trauma Dept, Barcelona, Spain

[42] Miguel Servet Univ Hosp, Trauma Dept, Zaragoza, Spain

[43] Hosp Arnau Vilanova, Trauma Dept, Lleida, Spain

[44] Complejo Asistencial Univ Burgos, Trauma Dept, Burgos, Spain

[45] Hosp Univ San Pedro, Dept Enfermedades Infecciosas, Logrono, Spain

[46] Univ Malaga, Hosp Univ Costa del Sol, Marbella, Spain

[47] Hosp Italiano Buenos Aires, Dept Trauma & Orthoped Surg, Buenos Aires, DF, Argentina

[48] Hosp Mar, Dept Radiol, Parc Salut Mar, Barcelona, Spain

[49] Univ Hosp Salamanca, Trauma Dept, Salamanca, Spain

[50] Hosp Univ St Joan deReus, Trauma Dept, Tarragona, Spain

来源：

JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY | 2024年 / 25卷 / 01期

关键词：

Periprosthetic fracture; Outcome; Mortality; Replacement; Fracture fixation; Geriatric co-management; Incidence; Epidemiology; Management; Frailty; HIP-ARTHROPLASTY; FEMORAL FRACTURES; MORTALITY; FEMUR; RISK; FIXATION; SURGERY; COHORT;

D O I：

10.1186/s10195-024-00746-6

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

Background The incidence of all periprosthetic fractures (PPF), which require complex surgical treatment associated with high morbidity and mortality, is predicted to increase. The evolving surgical management has created a knowledge gap regarding its impact on immediate outcomes. This study aimed to describe current management strategies for PPF and their repercussions for in-hospital outcomes as well as to evaluate their implications for the community. Methods PIPPAS (Peri-Implant PeriProsthetic Survival Analysis) was a prospective multicentre observational study of 1387 PPF performed during 2021. Descriptive statistics summarized the epidemiology, fracture characteristics, management, and immediate outcomes. A mixed-effects logistic regression model was employed to evaluate potential predictors of in-hospital mortality, complications, discharge status, and weight-bearing restrictions. Results The study encompassed 32 (2.3%) shoulder, 4 (0.3%) elbow, 751 (54.1%) hip, 590 (42.5%) knee, and 10 (0.7%) ankle PPF. Patients were older (median 84 years, IQR 77-89), frail [median clinical frailty scale (CFS) 5, IQR 3-6], presented at least one comorbidity [median Charlson comorbidity index (CCI) 5, IQR 4-7], were community dwelling (81.8%), and had outdoor ambulation ability (65.6%). Femoral knee PPF were most frequently associated with uncemented femoral components, while femoral hip PPF occurred equally in cemented and uncemented stems. Patients were managed surgically (82%), with co-management (73.9%), through open approaches (85.9%) after almost 4 days (IQR, 51.9-153.6 h), with prosthesis revision performed in 33.8% of femoral hip PPF and 6.5% of femoral knee PPF. For half of the patients, the discharge instructions mandated weight-bearing restrictions. In-hospital mortality rates were 5.2% for all PPF and 6.2% for femoral hip PPF. Frailty, age > 84 years, mild cognitive impairment, CFS > 3, CCI > 3, and non-geriatric involvement were candidate predictors for in-hospital mortality, medical complications, and discharge to a nursing care facility. Management involving revision arthroplasty by experienced surgeons favoured full weight-bearing, while an open surgical approach favoured weight-bearing restrictions. Conclusions Current arthroplasty fixation check and revision rates deviate from established guidelines, yet full weight-bearing is favoured. A surgical delay of over 100 h and a lack of geriatric co-management were related to in-hospital mortality and medical complications. This study recommends judicious hypoaggressive approaches. Addressing complications and individualizing the surgical strategy can lead to enhanced functional outcomes, alleviating the economic and social burdens upon hospital discharge.

引用

页数：17

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