[Risk factors and prevention strategies for periprosthetic femoral fractures in hip arthroplasty].
Risikofaktoren und Präventionsstrategien periprothetischer Femurfrakturen in der Hüftendoprothetik.
Bone mineral density
DXA
Osteoporosis
Periprosthetic fracture
Total hip arthroplasty
Journal
Orthopadie (Heidelberg, Germany)
ISSN: 2731-7153
Titre abrégé: Orthopadie (Heidelb)
Pays: Germany
ID NLM: 9918384887206676
Informations de publication
Date de publication:
24 Sep 2024
24 Sep 2024
Historique:
accepted:
21
08
2024
medline:
25
9
2024
pubmed:
25
9
2024
entrez:
24
9
2024
Statut:
aheadofprint
Résumé
Periprosthetic fractures represent a major complication following joint replacement surgery, particularly total hip arthroplasty (THA). Due to demographic changes, a rising number of THAs is expected to lead to an increase in periprosthetic femoral fractures (PPF) in the coming decades. Despite the resulting high clinical relevance, there is as yet no comprehensive overview of risk factors and possible preventive approaches to PPF. The aim of this review is to present current findings and data from various studies and to derive evidence-based recommendations for clinical practice. Narrative review. Various factors, such as advanced age, female sex, and rheumatic conditions, can increase the risk of PPF. In the presence of risk factors, a comprehensive assessment of bone health, including DXA osteodensitometry, should be considered prior to surgery. An individualized approach is essential in the planning and execution of THAs to minimize the risk of PPF. In cases of confirmed osteoporosis or for women aged ≥ 70 years and men aged ≥ 75 years, cemented stem fixation should be chosen, as uncemented stems are associated with an increased risk of PPF. Overall, the clinical risk profile should be considered in preoperative planning and postoperative care to reduce this complication and improve patient care. HINTERGRUND: Periprothetische Frakturen stellen eine bedeutende Komplikation der Endoprothetik dar, insbesondere nach Implantation einer Hüfttotalendoprothese (Hüft-TEP). Durch den demographischen Wandel wird prognostiziert, dass mit der steigenden Anzahl von Hüft-TEP-Implantationen auch eine Zunahme von periprothetischen Femurfrakturen (PPF) in den nächsten Jahrzehnten zu erwarten ist. Trotz der daraus abzuleitenden hohen klinischen Relevanz existiert bisher keine umfassende Übersicht zu Risikofaktoren und möglichen präventiven Ansätzen von PPF. Ziel dieser Übersichtsarbeit ist es, die aktuellen Erkenntnisse und Daten aus verschiedenen Studien darzustellen und daraus evidenzbasierte Empfehlungen für die klinische Praxis abzuleiten. Narratives Review. Das Auftreten von PPF kann durch verschiedene Risikofaktoren wie höheres Lebensalter, weibliches Geschlecht und rheumatische Erkrankungen begünstigt werden. Bei Vorliegen dieser Risikofaktoren sollte vor der Primäroperation die Indikation zur Untersuchung der Knochengesundheit, inklusive DXA-Messung, großzügig gestellt werden. Eine individualisierte Herangehensweise ist bei der Planung und Implantation einer Hüft-TEP essenziell, um das Risiko für PPF zu minimieren. Bei nachgewiesener Osteoporose oder einem Alter von ≥ 70 Jahren bei Frauen bzw. ≥ 75 Jahren bei Männern sollte eine zementierte Schaftverankerung gewählt werden, da zementfreie Schäfte in diesem Kontext mit einem erhöhten Risiko für PPF verbunden sind. Insgesamt sollte das klinische Risikoprofil bei der präoperativen Planung und der postoperativen Nachsorge berücksichtigt werden, um diese Komplikation zu reduzieren und die Patientenversorgung zu verbessern.
Sections du résumé
BACKGROUND
BACKGROUND
Periprosthetic fractures represent a major complication following joint replacement surgery, particularly total hip arthroplasty (THA). Due to demographic changes, a rising number of THAs is expected to lead to an increase in periprosthetic femoral fractures (PPF) in the coming decades. Despite the resulting high clinical relevance, there is as yet no comprehensive overview of risk factors and possible preventive approaches to PPF.
OBJECTIVES
OBJECTIVE
The aim of this review is to present current findings and data from various studies and to derive evidence-based recommendations for clinical practice.
METHODS
METHODS
Narrative review.
RESULTS
RESULTS
Various factors, such as advanced age, female sex, and rheumatic conditions, can increase the risk of PPF. In the presence of risk factors, a comprehensive assessment of bone health, including DXA osteodensitometry, should be considered prior to surgery.
CONCLUSIONS
CONCLUSIONS
An individualized approach is essential in the planning and execution of THAs to minimize the risk of PPF. In cases of confirmed osteoporosis or for women aged ≥ 70 years and men aged ≥ 75 years, cemented stem fixation should be chosen, as uncemented stems are associated with an increased risk of PPF. Overall, the clinical risk profile should be considered in preoperative planning and postoperative care to reduce this complication and improve patient care.
ZUSAMMENFASSUNG
UNASSIGNED
HINTERGRUND: Periprothetische Frakturen stellen eine bedeutende Komplikation der Endoprothetik dar, insbesondere nach Implantation einer Hüfttotalendoprothese (Hüft-TEP). Durch den demographischen Wandel wird prognostiziert, dass mit der steigenden Anzahl von Hüft-TEP-Implantationen auch eine Zunahme von periprothetischen Femurfrakturen (PPF) in den nächsten Jahrzehnten zu erwarten ist. Trotz der daraus abzuleitenden hohen klinischen Relevanz existiert bisher keine umfassende Übersicht zu Risikofaktoren und möglichen präventiven Ansätzen von PPF.
ZIEL DER ARBEIT
UNASSIGNED
Ziel dieser Übersichtsarbeit ist es, die aktuellen Erkenntnisse und Daten aus verschiedenen Studien darzustellen und daraus evidenzbasierte Empfehlungen für die klinische Praxis abzuleiten.
MATERIAL UND METHODEN
METHODS
Narratives Review.
ERGEBNISSE
UNASSIGNED
Das Auftreten von PPF kann durch verschiedene Risikofaktoren wie höheres Lebensalter, weibliches Geschlecht und rheumatische Erkrankungen begünstigt werden. Bei Vorliegen dieser Risikofaktoren sollte vor der Primäroperation die Indikation zur Untersuchung der Knochengesundheit, inklusive DXA-Messung, großzügig gestellt werden.
SCHLUSSFOLGERUNGEN
UNASSIGNED
Eine individualisierte Herangehensweise ist bei der Planung und Implantation einer Hüft-TEP essenziell, um das Risiko für PPF zu minimieren. Bei nachgewiesener Osteoporose oder einem Alter von ≥ 70 Jahren bei Frauen bzw. ≥ 75 Jahren bei Männern sollte eine zementierte Schaftverankerung gewählt werden, da zementfreie Schäfte in diesem Kontext mit einem erhöhten Risiko für PPF verbunden sind. Insgesamt sollte das klinische Risikoprofil bei der präoperativen Planung und der postoperativen Nachsorge berücksichtigt werden, um diese Komplikation zu reduzieren und die Patientenversorgung zu verbessern.
Autres résumés
Type: Publisher
(ger)
HINTERGRUND: Periprothetische Frakturen stellen eine bedeutende Komplikation der Endoprothetik dar, insbesondere nach Implantation einer Hüfttotalendoprothese (Hüft-TEP). Durch den demographischen Wandel wird prognostiziert, dass mit der steigenden Anzahl von Hüft-TEP-Implantationen auch eine Zunahme von periprothetischen Femurfrakturen (PPF) in den nächsten Jahrzehnten zu erwarten ist. Trotz der daraus abzuleitenden hohen klinischen Relevanz existiert bisher keine umfassende Übersicht zu Risikofaktoren und möglichen präventiven Ansätzen von PPF.
Identifiants
pubmed: 39317786
doi: 10.1007/s00132-024-04566-8
pii: 10.1007/s00132-024-04566-8
doi:
Types de publication
English Abstract
Journal Article
Review
Langues
ger
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
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