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Contribution of the remaining attachment index in the management of Vancouver B1 periprosthetic hip fracture.

Abstract：

INTRODUCTION:Implant fixation assessment following Vancouver B1 periprosthetic hip fracture is a major decision factor for internal fixation and/or implant revision. The main aim of the present study was to assess the correlation between radiographic Remaining Attachment Index (RAI) and risk of implant loosening at last follow-up following internal fixation of Vancouver B1 periprosthetic hip fracture. MATERIAL AND METHOD:A multicentre retrospective study included 50 patients with Vancouver B1 periprosthetic hip fracture with uncemented femoral stem between 2013 and 2019. Preoperative radiographs were analysed independently by 2 senior orthopedic surgeons, distinguishing 2 groups: RAI>2/3 versus<2/3. Postoperative and last follow-up radiographs were then screened for signs of complete femoral component loosening. RESULTS:Median age was 89 years (range: 36-99 years). Two RAI>2/3 patients showed implant loosening (8%) versus 9 RAI<2/3 patients (36%), disclosing a significant correlation between early loosening and RAI<2/3 (p=0.005). Interobserver agreement for both radiographic RAI and radiographic loosening assessment at last follow-up was 98% with kappa correlation coefficient 0.96 [range: 0.88-1]. CONCLUSION:Remaining Attachment Index<2/3 in Vancouver B1 periprosthetic hip fracture was a risk factor for early implant loosening after isolated internal fixation. In these often frail elderly patients, first-line implant exchange is to be considered in the light of the risk/benefit ratio. The present results confirm the need for rigorous preoperative radiographic work-up of the remaining attachment area in Vancouver B1 fracture. LEVEL OF EVIDENCE:IV.

journal_name

Orthop Traumatol Surg Res

journal_title

Orthopaedics & traumatology, surgery & research : OTSR

authors

Andriamananaivo T,Odri GA,Ollivier M,Mattesi L,Renault A,Rongieras F,Pesenti S,Severyns M

doi

10.1016/j.otsr.2020.06.016

subject

Has Abstract

pub_date

2020-11-01 00:00:00

pages

1413-1417

issue

7

issn

1877-0568

pii

S1877-0568(20)30263-2

journal_volume

106

pub_type

杂志文章

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