Perioperative Periprosthetic Femur Fractures are Strongly Correlated With Fixation Method: an Analysis From the American Joint Replacement Registry.

BACKGROUND: Perioperative periprosthetic femur fractures (PPFx) after total hip arthroplasty (THA) remain a leading cause of early stem failure and revision and are associated with high rates of morbidity and mortality. American Joint Replacement Registry (AJRR) data have been analyzed to determine the relationship of femoral stem fixation to PPFx revision. METHODS: All early (≤3 months from index arthroplasty) linked primary and revision hip arthroplasties reported to the AJRR between 2012 and 2017 were analyzed. We evaluated patient demographics, arthroplasty type (hemiarthroplasty vs THA), and stem fixation. RESULTS: A total of 10,277 linked revisions were reported to the AJRR during 2012-2017. Early PPFx requiring revision occurred in 628 patients (6.1%) due to osteoarthritis (82.4%), femoral neck fracture (12.1%), and other causes (15.6%). Five hundred twenty-nine patients (84%) were treated with THA and 99 patients with hemiarthroplasty (16%). Females (70%) have a higher prevalence of revisions. Fifty-eight percent of patients were ≥70 years of age, and 20% were ≥80 years of age. Patients with cementless stems were 2.6 times (account 94.9% of the fractures, 95% confidence interval 0.59-11.1) more likely to undergo early revision for PPFx than those with cemented fixation, although not statistically significant with its sample size. CONCLUSION: Mirroring other studies and national registries, there was an association between cementless fixation and PPFx in AJRR. Nevertheless, AJRR data demonstrate a trend of increasing utilization of cementless femoral fixation for THA and hemiarthroplasty, with cementless fixation accounting for 93% of THA stems with early periprosthetic fracture. Additional analysis is needed to better understand this phenomenon, especially in the elderly.

Mixed Treatment Comparisons for Nonsurgical Treatment of Knee Osteoarthritis: A Network Meta-analysis.

INTRODUCTION: Knee osteoarthritis (KOA) is a significant health problem with lifetime risk of development estimated to be 45%. Effective nonsurgical treatments are needed for the management of symptoms. METHODS: We designed a network meta-analysis to determine clinically relevant effectiveness of nonsteroidal anti-inflammatory drugs, acetaminophen, intra-articular (IA) corticosteroids, IA platelet-rich plasma, and IA hyaluronic acid compared with each other as well as with oral and IA placebos. We used PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to perform a systematic search of KOA treatments with no date limits and last search on October 7, 2015. Article inclusion criteria considered the following: target population, randomized controlled study design, English language, human subjects, treatments and outcomes of interest, ≥30 patients per group, and consistent follow-up. Using the best available evidence, two abstractors independently extracted pain and function data at or near the most common follow-up time. RESULTS: For pain, all active treatments showed significance over oral placebo, with IA corticosteroids having the largest magnitude of effect and significant difference only over IA placebo. For function, no IA treatments showed significance compared with either placebo, and naproxen was the only treatment showing clinical significance compared with oral placebo. Cumulative probabilities showed naproxen to be the most effective individual treatment, and when combined with IA corticosteroids, it is the most probable to improve pain and function. DISCUSSION: Naproxen ranked most effective among conservative treatments of KOA and should be considered when treating pain and function because of its relative safety and low cost. The best available evidence was analyzed, but there were instances of inconsistency in the design and duration among articles, potentially affecting uniform data inclusion.