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Title
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Periprosthetic fracture following anterior approach or dislocation after posterior approach : which one is the lesser evil?
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Author
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Institution/Organisation
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Ottawa Arthroplasty Group
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Abstract
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| IntroductionThe most common approaches in total hip arthroplasty (THA) have different complication profiles; anterior-approach (AA-THA) has an increased risk of periprosthetic fractures (PPF); posterior-approach (PA-THA) is associated with higher dislocation risk. However, the relative severity of one versus the other is unknown. This study aims to compare outcome of patients who suffered PPF after AA-THA with those that sustained dislocation after PA-THA.MethodsThis is a retrospective, single-center, multi-surgeon, consecutive case-series of primary THA patients. In a cohort of 9867 patients who underwent THA, 79 fulfilled the approach-specific, post-operative complication criteria, of which 44 were PPF after AA-THA and 35 with dislocation after PA-THA (age 67.9 years (range: 38.0-88.1), 58.2% women). Outcome included complication- and revision- rates, and patient-reported outcomes including Oxford Hip Score (OHS).ResultsAt 5.8 years follow-up (range: 2.0-18.5), reoperation was more common in the dislocation after PA-THA group (23/35 vs. 20/44; p = 0.072). Change of surgical approach occurred in 15/20 of patients with PPF after AA-THA, but none in those with dislocation after PA-THA. Following re-operation, complication rate was greater in the PPF group (9/20 vs. 4/23; p = 0.049). At latest follow-up, OHS were superior in the PPF after AA-THA group [42.6 (range: 25.0-48.0) vs. 36.6 (range: 21.0-47.0); p = 0.006].ConclusionDislocation following PA-THA is more likely to require revision. However, PPF following AA-THA requires more often a different surgical approach and is at higher risk of complications. Despite the increased surgical burden post-operative PROMs are better in the peri-prosthetic fracture group, especially in cases not requiring reoperation.Level of evidenceIII, case-control study |
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Language
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English
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Source (journal)
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Archives of orthopaedic and trauma surgery. - Berlin, 1988, currens
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Publication
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New york
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Springer
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2024
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ISSN
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0936-8051
[print]
1434-3916
[online]
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DOI
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10.1007/S00402-023-05034-2
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Volume/pages
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144
:1
(2024)
, p. 465-473
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ISI
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001063527900002
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Pubmed ID
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37620685
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Full text (Publisher's DOI)
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Full text (open access)
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Full text (publisher's version - intranet only)
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