■全关节置换术(TJA)后假体周围骨折(PPFs)可能是毁灭性的,然而,它们的长期影响还没有得到很好的描述。这项研究的目的是比较接受TJAPPF的患者与接受简单TJA的患者的长期结局。
■确定了在2005年至2014年间原发性TJA后持续PPF的患者。将17例接受至少2年随访的患者(PPF队列)与67例接受无并发症TJA的患者的匹配队列进行比较。人口统计数据,合并症,手术细节,并对并发症进行分析。使用12项简短形式健康调查(SF-12)评估生活质量和功能结果,西安大略省和麦克马斯德大学关节炎指数(WOMAC),膝关节功能评分。
■PPF组的总并发症发生率为41.2%,包括3处额外骨折(17.6%),2例伤口感染(11.8%),1例人工关节感染(5.8%),和一个痛苦的髌骨硬件需要移除(5.8%)。在2年,与对照组相比,PPF队列的SF-12的身体和精神成分均显着降低(SF-12-P,28.7±4.4vs40.8±10.3,P<.001,SF-12-M,36.7±5.07vs55.0±8.19,P<0.0001)。WOMAC疼痛和功能评分在2年的PPF队列中与对照组相比也明显更差(WOMAC-疼痛,38.8±29.9对87.4±22.1;P<.0001,WOMAC功能,40.7±8.7vs76.1±20.3;P<.0001)。在2年,在SF-12-physical的对照队列中,与PPF相比,从关节置换术前基线的评分改善明显更大,WOMAC-疼痛,和WOMAC功能。
TJA后持续PPFs的患者尽管接受了适当的治疗,但长期预后较差。这些结果可以帮助为患者提供咨询,并鼓励加大力度将PPF的风险降至最低。
■三级。
UNASSIGNED: Periprosthetic fractures (PPFs) after total joint arthroplasty (TJA) can be devastating, yet their long-term impact has not been well described. The aim of this study is to compare the long-term outcomes of patients who sustained a PPF about a TJA with those of patients who underwent an uncomplicated TJA.
UNASSIGNED: Patients who sustained a PPF after primary TJA between 2005 and 2014 were identified. Seventeen patients with a minimum 2-year follow-up (PPF cohort) were compared to a matched cohort of 67 patients who underwent uncomplicated TJA. Demographic data, comorbidities, surgical details, and complications were analyzed. Quality of life and functional outcomes were assessed with 12-Item Short Form Health Survey (SF-12), Western Ontario and McMasdter Universities Arthritis Index (WOMAC), and Knee Society Function Score.
UNASSIGNED: The overall complication rate was 41.2% in the PPF group, including 3 additional fractures (17.6%), 2 wound infections (11.8%), one prosthetic joint infection (5.8%), and one painful patellar hardware necessitating removal (5.8%). At 2 years, both physical and mental components of the SF-12 were significantly lower for the PPF cohort vs control (SF-12-P, 28.7 ± 4.4 vs 40.8 ± 10.3, P < .001, SF-12-M, 36.7 ± 5.07 vs 55.0 ± 8.19, P < .0001). WOMAC pain and function scores were also significantly worse in the PPF cohort vs control at 2 years (WOMAC-pain, 38.8 ± 29.9 vs 87.4 ± 22.1; P < .0001, WOMAC-function, 40.7 ± 8.7 vs 76.1 ± 20.3; P < .0001). At 2 years, score improvements from prearthroplasty baseline were significantly greater in the control cohort vs PPF for SF-12-physical, WOMAC-pain, and WOMAC-function.
UNASSIGNED: Patients who sustained PPFs following TJA have poor long-term outcomes despite appropriate treatment. These results can help counsel patients and encourage heightened efforts to minimize the risk of PPF.
UNASSIGNED: Level III.