FIXATION VERSUS REVISION ARTHROPLASTY FOR UNIFIED CLASSIFICATION SYSTEM TYPE B PERIPROSTHETIC FRACTURES AROUND POLISHED TAPERED STEMS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Résumé fourni par la source

Periprosthetic femoral fractures (PFF) around hip arthroplasty implants are increasingly common, and often occur in frail elderly patients. Polished taper-slip (PTS) cemented stems have been associated with increased PFF rates compared with other types of cemented stem. The optimal management of Unified Classification System (UCS) type B fractures around these stems remains an area of ongoing research. This systematic review and meta-analysis reviews the evidence relating to the management of UCS type B PFFs around PTS stems, comparing fixation (open reduction internal fixation – ORIF) and revision arthroplasty (RA). A database search was conducted using an inclusive search strategy. Abstracts and relevant full texts were screened and data were extracted by two authors independently. Reoperation or revision was the primary outcome measure, and the secondary outcome measures included mortality, blood transfusion requirements, and length of stay. The search yielded 4640 unique results, and after screening, four comparative studies were included in the final analysis. These were published between 2015–2023, including a total of 539 patients: 339 treated with ORIF and 200 treated with RA. There was a pooled 55.6% reduction in reoperation rate associated with ORIF compared to RA, although this did not reach statistical significance (p=0.1149). A non-significant trend was also noted towards increased mortality in the ORIF group: a 36% increase in 90-day mortality rate (p=0.6224), and a 55% increase in one-year mortality rate (p=0.0876). The ORIF group was associated with a significant 35% decrease in blood transfusion requirements (p=0.0047), as well as a significant decrease in mean length of stay (2.45 days, p=0.0418). Fixation alone may be beneficial when possible as it is associated with significantly reduced length of stay and blood transfusion. There is also a trend towards reduced reoperation and increased mortality, which may reflect a frailer patient group that receive this treatment, but neither of these findings reached statistical significance. Fixation is not suitable for all type B fractures, and so expertise is required to determine if there are features which necessitate stem revision.

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