The Effect of Periprosthetic Fractures Following Total Hip and Knee Arthroplasty on Long-Term Functional Outcomes and Quality of Life

IF 1.5 Q3 ORTHOPEDICS Arthroplasty Today Pub Date : 2024-08-13 DOI:10.1016/j.artd.2024.101418

Andrew Luzzi MD, Akshay Lakra MD, Taylor Murtaugh MD, Roshan P. Shah MD, JD, H. John Cooper MD, Jeffrey A. Geller MD

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引用次数: 0

Abstract

Background

Periprosthetic fractures (PPFs) after total joint arthroplasty (TJA) can be devastating, yet their long-term impact has not been well described. The aim of this study is to compare the long-term outcomes of patients who sustained a PPF about a TJA with those of patients who underwent an uncomplicated TJA.

Methods

Patients who sustained a PPF after primary TJA between 2005 and 2014 were identified. Seventeen patients with a minimum 2-year follow-up (PPF cohort) were compared to a matched cohort of 67 patients who underwent uncomplicated TJA. Demographic data, comorbidities, surgical details, and complications were analyzed. Quality of life and functional outcomes were assessed with 12-Item Short Form Health Survey (SF-12), Western Ontario and McMasdter Universities Arthritis Index (WOMAC), and Knee Society Function Score.

Results

The overall complication rate was 41.2% in the PPF group, including 3 additional fractures (17.6%), 2 wound infections (11.8%), one prosthetic joint infection (5.8%), and one painful patellar hardware necessitating removal (5.8%). At 2 years, both physical and mental components of the SF-12 were significantly lower for the PPF cohort vs control (SF-12-P, 28.7 ± 4.4 vs 40.8 ± 10.3, P < .001, SF-12-M, 36.7 ± 5.07 vs 55.0 ± 8.19, P < .0001). WOMAC pain and function scores were also significantly worse in the PPF cohort vs control at 2 years (WOMAC-pain, 38.8 ± 29.9 vs 87.4 ± 22.1; P < .0001, WOMAC-function, 40.7 ± 8.7 vs 76.1 ± 20.3; P < .0001). At 2 years, score improvements from prearthroplasty baseline were significantly greater in the control cohort vs PPF for SF-12-physical, WOMAC-pain, and WOMAC-function.

Conclusions

Patients who sustained PPFs following TJA have poor long-term outcomes despite appropriate treatment. These results can help counsel patients and encourage heightened efforts to minimize the risk of PPF.

Level of Evidence

Level III.

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全髋关节和膝关节置换术后假体周围骨折对长期功能效果和生活质量的影响

背景全关节置换术（TJA）后的假体周围骨折（PPF）可能是毁灭性的，但其长期影响尚未得到很好的描述。本研究的目的是比较在 TJA 后发生 PPF 的患者与接受无并发症 TJA 的患者的长期预后。将随访至少 2 年的 17 名患者（PPF 队列）与接受无并发症 TJA 的 67 名患者组成的匹配队列进行比较。对人口统计学数据、合并症、手术细节和并发症进行了分析。结果 PPF组的总并发症发生率为41.2%，其中包括3处额外骨折（17.6%）、2处伤口感染（11.8%）、1处假体关节感染（5.8%）和1处髌骨硬件疼痛导致必须切除（5.8%）。2年后，PPF队列与对照组相比，SF-12的身体和精神部分均显著降低（SF-12-P，28.7 ± 4.4 vs 40.8 ± 10.3，P < .001；SF-12-M，36.7 ± 5.07 vs 55.0 ± 8.19，P < .0001）。2年后，PPF组的WOMAC疼痛和功能评分也明显低于对照组（WOMAC-疼痛，38.8 ± 29.9 vs 87.4 ± 22.1；P <；.0001；WOMAC-功能，40.7 ± 8.7 vs 76.1 ± 20.3；P <；.0001）。2年后，对照组与PPF相比，SF-12-physical、WOMAC-pain和WOMAC-function的得分与关节成形术前基线相比有明显提高。这些结果有助于为患者提供咨询，鼓励他们加强努力，最大限度地降低PPF的风险。

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来源期刊

Arthroplasty Today Medicine-Surgery

CiteScore

2.90

自引率

0.00%

发文量

258

审稿时长

40 weeks

期刊介绍： Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.