Медицинская библиотека · Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2025
Internal fixation versus revision arthroplasty for Vancouver B2-B3 fractures: mortality and functional outcomes in frail patients. Insights from the PIPPAS study of 485 patients.
Moreta Jesús, Aguado Héctor J, Castillón-Bernal Pablo, Muñoz-Vives Josep M, Camacho Pilar, Jornet-Gibert Montsant, Teixidor Jordi, Pereda-Manso Adela, García-Sánchez Yaiza, Ojeda-Thies Cristina, García-Portabella Pablo, Álvarez Elvira Mateos, Noriega-González David, Muñoz-Moreno María-Fe, Arroyo-Hernantes Irene, Álvarez-Ramos Begoña Aránzazu, García-Medrano Belén, Martínez-Sellés Carmen, Marín-Jiménez Sergio, García-Virto Virginia, País-Ortega Sergio, Acha Adriana, Tomás-Hernández Jordi, Selga-Marsà Jordi, Andrés-Peiró José Vicente, Piedra-Calle Carlos, Blasco-Casado Ferrán, Guerra-Farfán Ernesto, Querolt-Coll Jordi, de Santamaría Guillermo Triana-López, Hernández José M, Renau-Cerrillo Marina, Gil-Aliberas Carles, Carreras-Castañer Anna, Vives-Barquiel Marian, Fernández Eliam Ajuria, Manzano Eugenia Fernández, De Cortázar Unai García, Arrieta Mirentxu, Escobar Daniel, Castrillo Estíbaliz, Balvis Balvis Patricia, Denisiuk Maciej, Menéndez Manuel Castro, Pastor Sonsoles, Larrazábal Ane, Olías-López Beatriz, Amaya-Espinosa Patricia, Boluda-Mengod Juan, González-Martín David, López-Dorado Daniel, Borrás-Cebrián Juan Carlos, Martínez-Pérez Carles, Pazmiño Patricio Andrés Freile, Calavia-Calé Pablo, Suárez-Suárez Miguel Ángel, Lanuza-Lagunilla Lucía, Arias Antonio García, Cabria-Fernández Julián, García-Coiradas Javier, Valle-Cruz José, Del Saz Jaime Sánchez, Mora-Fernández Jesús, Lalueza-Andreu Pedro, Bonome-Roel César, Cano-Leira María Ángeles, Carrasco Antonio Benjumea, Pariza Ana López-de, Fernández-Juan Alexis, la Puente Carmen Sevillano-de, Juldain-Mondragón Miren, Arsuaga Jorge Guadilla, Saura-Sánchez Eladio, Giménez-Ibáñez Sandra, Sánchez-Gómez Plácido, Ricón-Recarey F Javier, García García Elena M, Cuadrado-Abajo Francisco, Pérez-Núñez María Isabel, Del Pozo-Manrique Pedro, Navas-García Francisco Manuel García, García-Paredero Ester, Guijarro-Valtueña Ainhoa, Robles Teresa Beteta, Navas-Pernía Inés, De Villasante-Jirón Ignasi, Porta Teresa Serra, Becerra Carmen Carrasco, Otero-Naveiro Víctor, Paz Silvia Pena, Castrillo Inés Fernández-Billón, Fernández-Dorado Fátima, Martínez-Menduiña Amaia, Vaquerizo-García Víctor, Murcia-Asensio Antonio, Galián-Muñoz Elena, Marín-Martínez Carmelo, Muñoz-Vicente Adrián, Plaza-Salazar Nuria, Gámez-Asunción Carla, Benito-Santamaría Jennifer, Salgado-Tarrida Paula, Prats-Puente Oriol, Cuenca-Copete Alejandro, González-Montero Blas, Giraldo-Vegas Luis Alejandro, Mingo-Robinet Juan, Briso-Montiano Ricardo, Barbería-Biurrun Amaya, Escudero-Martínez Emma, Chouza-Montero Laura, Naharro-Tobío María, Gasset-Teixidor Alfons, Domínguez-Ibarrola Andrea, Peñalver J M, Serrano-Sanz Jorge, Roche-Albero Adrián, Martín-Hernández Carlos, Macho-Mier María, Saló-Cuenca José Carlos, Roselló Jordi Espona, Criado-Albillos Guillermo, Cabello-Benavides Hugo Gabriel, Nestar David Alonso, González-Bernal Jerónimo, González-Santos Josefa, Cunchillos-Pascual Jorge, Blasco Jorge Martínez-Íñiguez, Bogallo-Dorado José Manuel, Ramírez-Roldán Alicia, Cano-Porras Juan Ramón, Marqués-López Fernando, Martínez-Díaz Santos, Slullitel Pablo I, Carabelli Guido S, Astore Ignacio, Boietti Bruno Rafael, Córdova-Peralta Julio César, Hernández-Pascual Carlos, Rodríguez-Gangoso Alfredo, Dot-Pascuet Iván, Piñeiro-Borrero Ana, Pérez-Sánchez José María, Mandía-Martínez Alfonso, De Caso-Rodríguez Julio, Martín-Marcuello Jordi, Benito-Mateo Miguel, Alda-Gastiain Oiane, Corcuera-Elosegui Irene, González-Panisello María Rosa, Pérez-Salazar Nicolás Elizalde, De Sande-Díaz María
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеСравнительное исследованиеПеревод в очереди
Аннотация
BACKGROUND
Periprosthetic femoral fractures following hip arthroplasty (FH-PPF) represent a severe complication, especially in elderly patients with compromised health. Traditionally, revision arthroplasty is recommended for B2-B3 FH-PPF, yet internal fixation has emerged as a debated alternative in select patients. The hypothesis was that fixation, in selected patients with B2-B3 FH-PPF, decreases mortality and surgical complication rates with the same functional outcomes as revision arthroplasty.
MATERIALS AND
METHODS
PIPPAS is a multicenter prospective observational study. This cohort substudy includes 485 patients across 57 hospitals with B2-B3 FH-PPF between January 2021 and May 2023. Management strategy, revision or fixation, was at the attending surgeon's discretion. Propensity score matching, controlled for age, age-adjusted Charlson Comorbidity Index (a-CCI), prefracture mobility, Pfeiffer scale, and ASA score, was done. Mortality risk factors were assessed using univariate and multivariate analysis.
RESULTS
Out of 485 patients, 164 received fixation, and 321 underwent revision. Fixation patients were older (88 versus 82 years, p < 0.001) and frailer. Fixation was associated with shorter hospital stay (13 versus 15 days, p = 0.003) but higher 1-year mortality (25% versus 14.3%, p = 0.04). There were no differences in medical or surgical complications (p = 0.83 and p = 0.36) at any time, but dislocation rate was higher in the revision group (p = 0.001). The 1-year mortality rate in patients with no weight-bearing restrictions was higher for the revision group (p = 0.01). The propensity score matching showed higher 1-year mortality rate in the fixation group but no differences in functional outcomes, complications, or up to 6-months mortality. In the multivariate analysis a-CCI, cognitive impairment, B3 fractures, and prefracture independent walking impairment were independent mortality risk factors.
CONCLUSIONS
Revision arthroplasty showed less 1-year mortality rate and weight-bearing restrictions than fixation. However, frail patients with B2-B3 FH-PPF managed with fixation allowing full weight-bearing showed a lower 1-year mortality rate. Fixation in B2-B3 FH-PPF is a treatment option in frail patients, while aiming for stable constructions allowing full weight-bearing.
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