The value of megaprostheses in non-oncological fractures in elderly patients: A short-term results |
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| Institution: | 1. Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia;2. Università Cattolica Del Sacro Cuore, Roma, Italia;1. Orthopaedic Department, Hadassah Hebrew University Hospital, Jerusalem, Israel;2. Orthopedic Department, Shaare Zedek Medical Center, Jerusalem, Israel;3. Orthopedic Department, Emek Medical Center, Afula, Israel;1. Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, United States;2. University of Maryland School of Medicine, Baltimore, MD, United States;3. Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States;1. Speciality Registrar Trauma and Orthopaedics, Sheffield Teaching Hospital NHS Foundation Trust, England;2. Consultant Spinal Surgeon, Sheffield Teaching Hospital NHS Foundation Trust;1. BG Trauma Center Tübingen, Department for Traumatology and Reconstructive Surgery, Tübingen, Germany;2. BG Trauma Center Murnau, Department of Trauma Surgery, Murnau am Staffelsee, Germany;3. Charité University Medicine Berlin, Center for Musculoskeletal Surgery, Berlin, Germany;1. Hywel Dda University Health Board, Dept. of Orthopaedics, Prince Philip Hospital, Bryngwynmawr, Llanelli, SA14 8QF, NSW, United Kingdom;2. University of Bristol Medical School, First Floor, Tyndall Avenue, Bristol, BS8 1UD, United Kingdom;3. Swedish Arthroplasty Register, Registercentrum Västra Götaland, 413 45 Gothenburg, Sweden;4. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Box 400, 405 30, Gothenburg, Sweden;5. Dept. of Orthopaedics, Skåne University Hospital, Lund University, Södra Förstadsgatan 101, 205 02, Malmö, Sweden |
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| Abstract: | IntroductionThe management of both hip and distal femur fractures as well as periprosthetic fractures can be challenging for orthopaedic surgeons. The use of megaprosthetic implants could provide substantial advantages in elderly population affected by complex fractures. The aim of the study was to evaluate the effectiveness of megaprosthetic implants for treating hip and distal femur fractures as well as periprosthetic fractures in elderly.Material and MethodsFrom January 1st 2015 to December 31st 2019, patients treated for proximal or distal femoral fractures with severe bone loss or failure of previous surgery were retrospectively reviewed. Patients were divided into two group based on diagnosis: proximal femur fractures (group A) and distal femur fractures (group B). Subsequently, patients underwent hip (group A) or knee (group B) megaprosthesis. Self-assessed questionnaires were administered to all patients pre and postoperatively. Primary outcome was the Activity Daily Living. Secondary outcomes were: Instrumental Activity Daily Living, Short Form-12, Oxford knee or hip score, complications. Charlson score, Harris classification for hip or Anderson Orthopaedic Research Institute score and complication were recorded. All patients underwent a radiological follow up to rule out implant loosening and mobilization. Pre and postoperative functional score comparisons in each group were undertaken. Significance was set p ≤ 0.05.ResultsTwelve patients were finally included in the study. There were 6 male and 6 females, the mean age was 72,9 years old (± 7,4); the mean BMI was 29,8 points (± 4.5). The mean follow-up was 2.9 years (± 1.4). No differences could be found between pre and postoperative evaluation in each group. No aseptic loosening, dislocation, mobilization or radiolucency were recorded during the follow-up. In group A, two surgical site infections (2/6 patients) and one pneumonia (1/6 patients) were recorded. In group B, two surgical site infections occurred (2/6 patients). All patients were treated by antimicrobial oral therapy with complete regression.ConclusionThe use of hip and knee megaprosthetic implants in traumatology is a safe and viable option in elderly patients. |
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