Is there a difference in pelvic and femoral morphology in early periprosthetic femoral fracture in cementless short stem total hip arthroplasty via an anterolateral approach?

IF 3 2区 医学 Q1 ORTHOPEDICS Journal of Orthopaedics and Traumatology Pub Date : 2024-11-04 DOI:10.1186/s10195-024-00795-x
Matthias Luger, Sandra Feldler, Clemens Schopper, Tobias Gotterbarm, Christian Stadler
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Abstract

Background: The pelvic and femoral morphology are associated with the occurrence of early periprosthetic femoral fractures (PFFs) in cementless total hip arthroplasty (THA). Differences exist depending on the performed approach and implanted stem design. Therefore, this study was conducted to analyze the pelvic and femoral morphology in cementless short stem THA via a minimally-invasive (MIS) anterolateral approach.

Methods: A retrospective, single-center, multi-surgeon, comparative propensity-score matched study of a cohort of 1826 short stem THAs was conducted. A total of 39 PFFs within the first 90 days after surgery was matched on a 2:1 ratio to non-fracture patients. The morphology of the proximal femur was analyzed with canal flare index (CFI), canal-calcar ratio (CCR), canal-bone ratio (CBR), morphological cortical index (MCI), and femoral cortical index (CI). The pelvic morphology was analyzed with ilium-ischial ratio (IR), distance anterior superior iliac spine to the tip of the greater trochanter (AGT). Both groups were analyzed regarding several parameters for femoral and pelvic morphology in non-parametric testing and univariate regression analysis.

Results: A significantly higher AGT was detected in the fracture group (104.5 mm ± 18 versus 97.4 mm ± 9.8; p = 0.016). All other femoral and pelvic parameters did not differ between both groups, also when compared depending on the Vancouver type of the PFF.

Conclusions: The morphology of the proximal femur and the pelvis do not differ in several radiological parameters in patients sustaining a PFF in cementless short stem THA via an anterolateral approach compared with matched non-fracture group. The findings are controversial to other studies with different stem types and approaches. Future studies should focus on analyzing the influence of the pelvic geometry and the shape of the proximal femur in the occurrence of PFFs in different approaches with the same stem type and vice versa. Level of Evidence Level III case-controlled study.

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经前外侧入路的无骨水泥短柄全髋关节置换术中早期股骨假体周围骨折的骨盆和股骨形态是否存在差异?
背景:骨盆和股骨形态与无骨水泥全髋关节置换术(THA)中早期股骨假体周围骨折(PFF)的发生有关。不同的手术方法和植入的骨干设计存在差异。因此,本研究分析了通过微创(MIS)前外侧入路进行无骨水泥短柄全髋关节置换术的骨盆和股骨形态:方法: 对1826例短柄THA进行了一项回顾性、单中心、多外科医生、倾向分数匹配比较研究。共有 39 名在术后 90 天内发生 PFF 的患者与非骨折患者按 2:1 的比例进行了匹配。股骨近端形态的分析包括股骨管外翻指数(CFI)、股骨管-髋臼比率(CCR)、股骨管-骨比率(CBR)、形态皮质指数(MCI)和股骨皮质指数(CI)。骨盆形态通过髂骨-髂骨比(IR)、髂前上棘到大转子尖的距离(AGT)进行分析。通过非参数检验和单变量回归分析,对两组患者的股骨和骨盆形态的多个参数进行了分析:结果:骨折组的 AGT 明显更高(104.5 mm ± 18 对 97.4 mm ± 9.8;P = 0.016)。所有其他股骨和骨盆参数在两组之间没有差异,同样也是根据PFF的温哥华类型进行比较:结论:与匹配的非骨折组相比,通过前外侧入路进行无骨水泥短柄THA的PFF患者的股骨近端和骨盆形态在多个放射学参数上没有差异。这些研究结果与其他采用不同骨干类型和方法的研究结果存在争议。今后的研究应重点分析骨盆几何形状和股骨近端形状对采用相同骨干类型的不同方法发生PFF的影响,反之亦然。证据级别 III级病例对照研究。
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来源期刊
Journal of Orthopaedics and Traumatology
Journal of Orthopaedics and Traumatology Medicine-Orthopedics and Sports Medicine
CiteScore
4.30
自引率
0.00%
发文量
56
审稿时长
13 weeks
期刊介绍: The Journal of Orthopaedics and Traumatology, the official open access peer-reviewed journal of the Italian Society of Orthopaedics and Traumatology, publishes original papers reporting basic or clinical research in the field of orthopaedic and traumatologic surgery, as well as systematic reviews, brief communications, case reports and letters to the Editor. Narrative instructional reviews and commentaries to original articles may be commissioned by Editors from eminent colleagues. The Journal of Orthopaedics and Traumatology aims to be an international forum for the communication and exchange of ideas concerning the various aspects of orthopaedics and musculoskeletal trauma.
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