OTA 2012 Posters

Scientific Poster #8 Hip/Femur OTA-2012

Proximal Femoral Replacement in the Management of Acute Periprosthetic Fractures of the Hip: A Competing Risks Survival Analysis

Matthew Colman, MD1; Lisa Choi, MD1; Antonia Chen, MD1; Dan Winger, MS2;
*Peter Siska, MD1; Mark Goodman, MD1; Lawrence Crossett, MD1; Ivan S. Tarkin, MD1;
Richard McGough, MD1;
1Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA;
2Clinical and Translational Science Institute (CTSI), University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Background/Purpose: With advancing osteopenia, lytic defects, and a history of revision, hip arthroplasty patients are exposed to massive failure of implants at the time of periprosthetic fracture. This study examines the outcomes of proximal femoral replacement (PFR) as compared to revision total hip arthroplasty (REV) or open reduction and internal fixation (ORIF) in these non-oncologic hosts.

Methods: 101 consecutive periprosthetic hip fractures were treated at our center with average 35-month follow-up. Three treatment groups were identified: PFR (n = 23), REV (n = 20), and ORIF (n = 58). We recorded comorbidities, fracture type, treatment profiles, complications, and mortality. The three groups were compared using competing risks survival analysis, a Kaplan-Meier–like estimate that takes into account multiple competing outcomes.

Results: The PFR group was similar to the REV and ORIF groups in all respects except for its higher incidence of pulmonary disease and Vancouver B3 fractures. Competing risk survival analysis using a Gray comparison of overall mortality during the mean 35-month follow-up showed no difference between the three groups (P = 0.65; 12 and 60-month mortality for PFR: 37%, 45%; REV: 16%, 46%; ORIF: 14%, 100%). However, implant survival was worse for the PFR group (P = 0.03; 12 and 60-month implant survival rate for PFR: 95%, 61%; REV: 93%, 93%; ORIF 98%, 98%). There was no difference between groups with regard to summary nondeath complications including deep vein thrombosis, infection, dislocation, and other measures (30% vs 40% vs 34%, P = 0.80). Comparing only the PFR group to the REV group, PFR had a trend toward higher dislocation (26% vs 5%, P = 0.062), although infection rates (17% vs 15%, P = 0.83) were not different. Operative times were not different between the three groups (172 min vs 162 min vs 168 min, P = 0.92).

Conclusions: In treating difficult periprosthetic fractures, PFR as compared with REV or ORIF has worse medium-term implant survival, similar perioperative complication rates, similar short and long-term mortality, and similar operative times. Caution should be used when considering the use of this implant in nononcologic hosts with long-term life expectancy

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.