Effect of Fracture Type,Treatment, and Surgeon Training on Reoperation After Vancouver B Periprosthetic Femur Fractures |
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| Institution: | 5. Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts;6. Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia;7. Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas;8. Department of Orthopaedic Surgery, University of Washington, Seattle, Washington;9. Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York;10. Department of Orthopaedic Surgery, Stanford University, Redwood City, California;11. Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia;12. Department of Orthopaedic Surgery, Loma Linda University Health, Loma Linda, California;13. Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, Texas;1. Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;2. Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas;3. Department of Orthopaedic Surgery, Vanderbilt University, Nashville, Tennessee;4. Novant Health Orthopaedics and Sports Medicine, Winston-Salem, North Carolina;1. Orthopaedic + Fracture Specialists, Portland, Oregon;2. Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri;3. Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts;4. Connecticut Orthopaedics, Hamden, Connecticut;5. Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana;6. Department of Orthopaedic Surgery, Mid-Atlantic Permanente Medical Group, Washington, District of Columbia;7. Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania;1. Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas;2. Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana;1. Department of Orthopaedic Surgery, Stanford University, Redwood City, California;2. Stanford University School of Medicine, Stanford, California |
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| Abstract: | BackgroundThe treatment of Vancouver B periprosthetic proximal femur fractures (PPFFs) is complex due to the overlap between arthroplasty and orthopedic trauma techniques. Our purpose was to assess the effects of fracture type, treatment difference, and surgeon training on the risk of reoperation in Vancouver B PPFF.MethodsA collaborative research consortium of 11 centers retrospectively reviewed PPFFs from 2014 to 2019 to determine the effects of variations in surgeon expertise, fracture type, and treatment on surgical reoperation. Surgeons were classified as per fellowship training, fractures using the Vancouver classification, and treatment as open reduction internal fixation (ORIF) or revision total hip arthroplasty with or without ORIF. Regression analyses were performed with reoperation as the primary outcome.ResultsFracture type (Vancouver B3 versus B1: odds ratio OR]: 5.70) was an independent risk factor for reoperation. No differences were found in reoperation rates with treatment (ORIF versus revision: OR 0.92, P = .883). Treatment by a nonarthroplasty-trained surgeon versus an arthroplasty specialist led to higher odds of reoperation in all Vancouver B fracture (OR: 2.87, P = .023); however, no significant differences were seen in the Vancouver B2 group alone (OR: 2.61, P = .139). Age was a significant risk factor for reoperation in all Vancouver B fractures (OR: 0.97, P = .004) and in the B2 fractures alone (OR: 0.96, P = .007).ConclusionOur study suggests that age and fracture type affect reoperation rates. Treatment type did not affect reoperation rates and the effect of surgeon training is unclear. |
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| Keywords: | periprosthetic proximal femur fracture revision total hip arthroplasty open reduction internal fixation surgeon specialty training arthroplasty orthopedic trauma |
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