Periprosthetic Femoral Fractures-Beyond B2.

Chika Edward Uzoigwe, Arun Thor Watts, Praise Briggs, Tom Symes
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Abstract

The proliferation of hip arthroplasty has seen concomitant increases in periprosthetic femoral fractures (PFFs). The most common pattern involves fracture at the level of a loose prosthesis (B2). B2 PFFs have a unique mechanopathogenesis linked to the tendency of polished taper-slip cemented stems to subside in the cement. Such stems carry a much higher PFF risk than other cemented designs. Mega-data, consistent across national registries, suggest that increasing application of the taper-slip principle has resulted in the emergence of highly polished, very low friction cemented prostheses. These have the propensity to migrate within the cement, increasing B2 PFF risk. This would explain the strong association between cobalt-chromium stems and PFF. Is PFF the mode of failure of polished taper-slip stems rather than aseptic loosening? Established wisdom teaches that B2 PFFs should be managed with revision surgery. There is a large body of new evidence that, in certain instances, fixation results in outcomes at least equivalent to revision arthroplasty, with shorter surgical time, decreased transfusion requirements, and lower dislocation risk. This is so in B2 PFFs around cemented polished taper-slip stems with an intact bone-cement interface. We outline advances in understanding of B2 PFF with special reference to mechanopathogenesis and indications for fixation.

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股骨假体周围骨折--超越 B2。
随着髋关节置换术的普及,股骨假体周围骨折(PFF)也随之增加。最常见的模式是松动假体(B2)水平骨折。B2 PFF具有独特的机械发病机制,与抛光锥形滑动骨水泥柄在骨水泥中下沉的趋势有关。与其他骨水泥设计相比,这种骨水泥柄的PFF风险要高得多。各国登记处的大量数据一致表明,锥滑原理的应用日益广泛,导致了高抛光、极低摩擦的骨水泥假体的出现。这些假体有在骨水泥内移位的倾向,增加了 B2 PFF 风险。这就解释了钴铬基台与PFF之间的密切联系。PFF是抛光锥滑柄的失效模式而非无菌性松动吗?已有的观点认为,B2 PFF 应通过翻修手术来处理。大量新证据表明,在某些情况下,固定的结果至少与翻修关节成形术相当,手术时间更短、输血需求更少、脱位风险更低。在骨水泥界面完整的骨水泥抛光锥形滑动柄周围的 B2 PFF 就是如此。我们概述了对B2 PFF的认识进展,特别提到了力学发病机制和固定适应症。
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来源期刊
CiteScore
2.60
自引率
6.70%
发文量
282
审稿时长
8 weeks
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