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1.
J Arthroplasty ; 39(8): 2104-2110.e1, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38437886

RESUMO

BACKGROUND: In patients who have hip fractures, treatment within 24 hours reduces mortality and complication rates. A similar relationship can be assumed for patients who have hip periprosthetic femoral fractures (PPFs) owing to the similar baseline characteristics of the patient populations. This monocentric retrospective study aimed to compare the complication and mortality rates in patients who had hip PPF treated within and after 24 hours. METHODS: In total, 350 consecutive patients who had hip PPF in a maximum-care arthroplasty and trauma center between 2006 and 2020 were retrospectively evaluated. The cases were divided into 2 groups using a time to surgery (TTS) of 24 hours as the cutoff value. The primary outcome variables were operative and general complications as well as mortalities within 1 year. RESULTS: Overall, the mean TTS was 1.4 days, and the 1-year mortality was 14.6%. The TTS ≤ 24 hours (n = 166) and TTS > 24 hours (n = 184) groups were comparable in terms of baseline characteristics and comorbidities. Surgical complications were equally frequent in the 2 groups (16.3 versus 15.2%, P = .883). General complications occurred significantly more often in the late patient care group (11.4 versus 28.3%, P < .001). In addition, the 30-day mortality (0.6 versus 5.5%, P = .012), and 1-year mortality (8.3 versus 20.5%, P = .003) rates significantly increased in patients who had TTS > 24 hours. Cox regression analysis yielded a hazard ratio of 4.385 (P < .001) for the TTS > 24 hours group. CONCLUSIONS: Prompt treatment is required for patients who have hip PPF to reduce mortality and overall complications.


Assuntos
Artroplastia de Quadril , Fraturas Periprotéticas , Complicações Pós-Operatórias , Humanos , Feminino , Masculino , Idoso , Fraturas Periprotéticas/cirurgia , Fraturas Periprotéticas/mortalidade , Fraturas Periprotéticas/etiologia , Estudos Retrospectivos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/mortalidade , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Pessoa de Meia-Idade , Tempo para o Tratamento/estatística & dados numéricos , Fraturas do Fêmur/cirurgia , Fraturas do Fêmur/mortalidade , Fraturas do Quadril/cirurgia , Fraturas do Quadril/mortalidade , Fatores de Tempo
2.
Eur J Orthop Surg Traumatol ; 34(4): 2099-2105, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38551739

RESUMO

PURPOSE: There is a global trend of increased periprosthetic fractures due to the growing number of arthroplasty procedures. The present study assessed the impact of factors such as time to surgery and type of surgery on the outcomes, which have been seldom evaluated for periprosthetic fractures. METHODS: An observational study was conducted on consecutive 87 patients within an NHS district hospital trust in the UK. Patients who underwent a complete hip replacement prior to the fracture, received fixation therapy, or underwent revision surgery within the specified time were screened. Patients were grouped in two ways: based on time to surgery and based on surgery type. Logistic regression models were performed to assess for statistically significant differences in post-operative complication, 30-day, and 1-year mortality rates between groups, whilst adjusting for age, gender, and ASA grade. RESULTS: Forty-one patients underwent open reduction and internal fixation (ORIF), 29 patients underwent revision arthroplasty, and 17 patients were subjected to both, ORIF and revision arthroplasty. Sixty of the 87 patients were operated on > 48 h of injury. The median hospital stay was significantly lower in the ORIF plus revision arthroplasty group, versus other surgical groups (p < 0.05) whilst it was significantly higher in the group of patients who underwent surgery after 48 h of injury (p < 0.05). Numerically higher mortality was noted in the revision arthroplasty group (31.03%, p > 0.05). The group that was operated after 48 h of injury showed greater mortality but was comparable to the other group (25% vs. 14.81%, p > 0.05). For post-operative complications, none of the variables were significantly predictive (p > 0.05). However, for 30-day mortality, ASA grade (p = 0.04) and intra-operative complications (p = 0.0001) were significantly predictive. Additionally, for 1-year mortality, ASA grade (p = 0.004) was noted to be significantly predictive. CONCLUSION: Revision and delayed periprosthetic fracture management (> 48 h after injury) group showed a numerically greater mortality risk; however, this finding was not statistically significant. ASA grading at baseline is predictive of mortality for periprosthetic fractures.


Assuntos
Artroplastia de Quadril , Fixação Interna de Fraturas , Tempo de Internação , Fraturas Periprotéticas , Complicações Pós-Operatórias , Reoperação , Humanos , Feminino , Masculino , Artroplastia de Quadril/métodos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/mortalidade , Reoperação/estatística & dados numéricos , Fraturas Periprotéticas/cirurgia , Fraturas Periprotéticas/mortalidade , Fraturas Periprotéticas/etiologia , Idoso , Reino Unido/epidemiologia , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/mortalidade , Tempo de Internação/estatística & dados numéricos , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/etiologia , Fraturas do Quadril/cirurgia , Fraturas do Quadril/mortalidade , Pessoa de Meia-Idade , Tempo para o Tratamento/estatística & dados numéricos , Resultado do Tratamento , Redução Aberta/métodos , Fatores de Tempo , Medicina Estatal
3.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(2): 92-98, mar.-abr. 2020. tab, graf
Artigo em Espanhol | IBECS (Espanha) | ID: ibc-196236

RESUMO

INTRODUCCIÓN: Está aumentando la incidencia de las fracturas periprotésicas de rodilla debido al incremento en el número de artroplastias totales de rodilla realizadas, junto al envejecimiento poblacional. Encontramos escasos estudios que analicen en nuestro medio la mortalidad a largo plazo tras la intervención quirúrgica. Nuestro objetivo fue evaluar la mortalidad y la supervivencia tras el tratamiento quirúrgico de las fracturas periprotésicas de fémur distal en nuestro medio. MATERIAL Y MÉTODOS: Realizamos un estudio observacional retrospectivo de una serie consecutiva de 97 pacientes intervenidos quirúrgicamente en nuestro centro por fractura periprotésica de rodilla entre los años 2007 y 2015, con un seguimiento mínimo de 12 meses. Se analizaron estadísticamente diversas variables sociodemográficas, clínicas y quirúrgicas. Se realizó una consulta al índice nacional de defunciones del Ministerio de Sanidad para el análisis de mortalidad y se analizó la supervivencia utilizando el método Kaplan-Meier. RESULTADOS: Revisamos un total de 97 pacientes con edad media de 75años, de los cuales 86 fueron mujeres y 11 fueron hombres. El 50,5% de los pacientes presentaban alguna comorbilidad. La demora media hasta la intervención fue de 3,1 días. Respecto al tratamiento, 45 pacientes fueron intervenidos mediante osteosíntesis con placa (49,5%), 40 de ellos con clavo intramedular (41,2%) y en 9 se realizó una revisión de la artroplastia (9,3%). Se registraron un total de 30 defunciones durante el seguimiento, con una mortalidad acumulada al año, a los 3años y a los 10 años del 7,2, del 17,5 y del 30,9%, respectivamente, aumentando progresivamente en mayores de 75 años. No hubo diferencias significativas en las tasas de mortalidad respecto al método de osteosíntesis. La principal complicación fue la seudoartrosis (6,2%). CONCLUSIONES: Las fracturas periprotésicas de rodilla se asocian a altas tasas de complicaciones y de mortalidad, siendo la edad del paciente y la propia lesión factores no modificables que pueden influir en la mortalidad tras la cirugía, mientras que otras variables, como el tipo de intervención o la demora quirúrgica, no mostraron diferencias en las tasas de mortalidad en nuestro estudio


INTRODUCTION: The incidence of periprosthetic fractures of the knee is increasing due to the increase in the number of total knee arthroplasties performed, together with population aging. We found few studies that analyze mortality in our setting after surgery. Our objective was to evaluate mortality and survival after surgical treatment of periprosthetic fractures of the distal femur in our environment. MATERIAL AND METHOD: We conducted a retrospective observational study of a consecutive series of 97 patients surgically treated in our centre for periprosthetic knee fracture between 2007-2015, with a minimum follow-up of 12 months. Diverse sociodemographic, clinical and surgical variables were analyzed. A consultation was made to the National Death Index of the Ministry of Health for the analysis of mortality and survival was analyzed using the Kaplan-Meier method. RESULTS: We reviewed a total of 97 patients with an average age of 75 years, of which 86 were women and 11 were men. Of the patients, 50.5% of patients had some comorbidity. The average delay until the intervention was 3.1 days. With respect to the treatment, 45 patients were operated by osteosynthesis with plate (49.5%), 40 with intramedullary nail (41.2%) and 9 with revision of the arthroplasty (9.3%). A total of 30 deaths were recorded during the follow-up, with cumulative mortality in the first year, at 3 and at 10 years of 7.2%, 17.5% and 30.9%, respectively, progressively increasing in people over 75 years. There was no significant difference in mortality rates with the osteosynthesis method. The main complication was pseudoarthrosis (6.2%). CONCLUSIONS: Periprosthetic knee fractures are associated with high rates of complications and mortality. The patient's age and the lesion itself are non-modifiable factors that can influence mortality after surgery, while other variables such as the type of intervention or surgical delay did not show differences in mortality rates in our study


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fraturas do Fêmur/mortalidade , Fraturas do Fêmur/cirurgia , Fixação de Fratura/mortalidade , Fraturas Periprotéticas/mortalidade , Fraturas Periprotéticas/cirurgia , Fatores Etários , Seguimentos , Fixação de Fratura/métodos , Estimativa de Kaplan-Meier , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
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