Optimizing periprosthetic fracture management and in-hospital outcome: insights from the PIPPAS multicentric study of 1387 cases in Spain

Background The incidence of all periprosthetic fractures (PPF), which require complex surgical treatment associated with high morbidity and mortality, is predicted to increase. The evolving surgical management has created a knowledge gap regarding its impact on immediate outcomes. This study aimed t...

Descripción completa

Detalles Bibliográficos
Autores: Aguado, HJ, Castillón-Bernal, P, Teixidor-Serra, J, Garcia-Sanchez, Y, Muñoz-Vives, JM, Camacho-Carrasco, P, Jornet-Gibert, M, Ojeda-Thies, C, García-Portabella, P, Pereda-Manso, A, Mateos-Alvarez, E, Manzano-Mozo, J, Carrillo-Gómez, R, País-Ortega, S, García-Virto, V, Noriega-González, D, Alvarez-Ramos, BA, Ganso-Pérez, A, Cervera-Díaz, C, Plata-García, M, Ortega-Briones, A, Berrocal-Cuadrado, J, del Rey-Machimbarrena, DC, Salvador, J, Rey, L, Tomas-Hernández, J, Selga-Marsà, J, Andrés-Peiró, JV, Querolt-Coll, J, Triana, G, Vives-Barquiel, M, Renau-Cerrillo, M, Campuzano-Bitterling, B, Hernández, JM, Ostilla, R, Carreras-Castañer, A, Torner, P, Díaz-Suárez, R, Fernández, EA, Olaya-González, C, Fernandez-Villan, M, De Cortázar, UG, Arrieta, M, Escobar, D, Castrillo, E, Balvis, P, Arenas, MR, Perez, AG, Moreta, J, Bidea, I, Jiménez-Urrutia, X, Olías-López, B, Boluda-Mengod, J, González-Martín, D, Goitiandia, LB, Dorado, DL, Borrás-Cebrián, JC, García-Aguilera, D, Pazmiño, PAF, Suárez, MAS, Lagunilla, LL, Arias, AG, Sanchez-Saz, J, Garcia-Coiradas, J, Valle-Cruz, J, Mora-Fernandez, J, Leira, MAC, Rieiro, G, Carrasco, AB, Priego-Sánchez, RJ, Sánchez-Perez, C, Guadilla-Arsuaga, J, Fernandez-Juan, A, Sanchez, P, Ricon, J, Fuentes-Diaz, A, Garcia-Garcia, EM, Cuadrado-Abajo, F, Garcia-Portal, G, del PozoManrique, P, del Pozo, VC, Garcia-Navas, FM, Garcia-Paredero, E, Beteta-Robles, T, Guijarro-Valtuena, A, Gutierrez-Baiget, G, Alonso-Garcia, N, Navas-Pernia, I, Ariza-Herrera, D, Vilanova, J, Videla-Ces, M, Serra-Porta, T, Vazquez-Garcia, C, Carrasco-Becerra, C, Pena-Paz, S, Otero-Naveiro, V, Fernandez-Billon-Castrillo, I, Martinez-Menduina, A, Hernandez-Galera, C, Fernandez-Dorado, F, Madrigal-Lopez, M, Murcia-Asensio, A, Galian-Munoz, E, Castro-Sauras, A, Espallargas-Donate, T, Royo-Agustin, M, Plaza-Salazar, N, Gamez-Asuncion, C, Munoz-Vicente, A, Pareja-Sierra, T, Benito-Santamaria, J, Cuenca-Copete, A, Verdejo-Gonzalez, A, Gonzalez-Montero, B, Giraldo-Vegas, LA, Alonso-Viana, L, Diez-Perez, EJ, Briso-Montiano, R, Andres, AI, Mingo-Robinet, J, Naharro-Tobio, M, Escudero-Martinez, E, Serrano-Sanz, J, Penalver-Matamoros, JM, Fernandez-Poch, N, Martinez-Carreres, L, Macho-Mier, M, Martin-Hernandez, C, Lacleriga-Gimenez, AF, Salo-Cuenca, JC, Salamanca-Ontiveros, C, Espona-Rosello, J, Altemir-Martinez, V, Criado-Albillos, G, Cunchillos-Pascual, J, Millan-Cid, M, Cabello-Benavides, HG, Martinez-iniguez-Blasco, J, Sevilla-Ortega, P, Cano, JR, Ramirez, A, Marques-Lopez, F, Martinez-Diaz, S, Carabelli, GS, Slullitel, PA, Astore, I, Boietti, BR, Hernandez-Pascual, C, Marin-Sanchez, J, Cordova-Peralta, JC, Dot-Pascuet, I, Pereira-Mosquera, E, Martin-Antunez, J, Perez, JM, Mandia-Martinez, A, De Caso, J, Martin-Marcuello, J, Benito-Mateo, M, Murillo-Vizuete, AD, Delgado, LG, dela Herran, G, Nunes, N, Perez-Coto, I, Gonzalez-Panisello, MR, Iglesias-Fernandez, S, Ruete-Gil, GL, Ramos-Garcia, S, Villarreal, JP
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p17440
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/17440
Access Level:acceso abierto
Palabra clave:Periprosthetic fracture
Outcome
Mortality
Replacement
Fracture fixation
Geriatric co-management
Incidence
Epidemiology
Management
Frailty
Descripción
Sumario:Background The incidence of all periprosthetic fractures (PPF), which require complex surgical treatment associated with high morbidity and mortality, is predicted to increase. The evolving surgical management has created a knowledge gap regarding its impact on immediate outcomes. This study aimed to describe current management strategies for PPF and their repercussions for in-hospital outcomes as well as to evaluate their implications for the community. Methods PIPPAS (Peri-Implant PeriProsthetic Survival Analysis) was a prospective multicentre observational study of 1387 PPF performed during 2021. Descriptive statistics summarized the epidemiology, fracture characteristics, management, and immediate outcomes. A mixed-effects logistic regression model was employed to evaluate potential predictors of in-hospital mortality, complications, discharge status, and weight-bearing restrictions. Results The study encompassed 32 (2.3%) shoulder, 4 (0.3%) elbow, 751 (54.1%) hip, 590 (42.5%) knee, and 10 (0.7%) ankle PPF. Patients were older (median 84 years, IQR 77-89), frail [median clinical frailty scale (CFS) 5, IQR 3-6], presented at least one comorbidity [median Charlson comorbidity index (CCI) 5, IQR 4-7], were community dwelling (81.8%), and had outdoor ambulation ability (65.6%). Femoral knee PPF were most frequently associated with uncemented femoral components, while femoral hip PPF occurred equally in cemented and uncemented stems. Patients were managed surgically (82%), with co-management (73.9%), through open approaches (85.9%) after almost 4 days (IQR, 51.9-153.6 h), with prosthesis revision performed in 33.8% of femoral hip PPF and 6.5% of femoral knee PPF. For half of the patients, the discharge instructions mandated weight-bearing restrictions. In-hospital mortality rates were 5.2% for all PPF and 6.2% for femoral hip PPF. Frailty, age > 84 years, mild cognitive impairment, CFS > 3, CCI > 3, and non-geriatric involvement were candidate predictors for in-hospital mortality, medical complications, and discharge to a nursing care facility. Management involving revision arthroplasty by experienced surgeons favoured full weight-bearing, while an open surgical approach favoured weight-bearing restrictions. Conclusions Current arthroplasty fixation check and revision rates deviate from established guidelines, yet full weight-bearing is favoured. A surgical delay of over 100 h and a lack of geriatric co-management were related to in-hospital mortality and medical complications. This study recommends judicious hypoaggressive approaches. Addressing complications and individualizing the surgical strategy can lead to enhanced functional outcomes, alleviating the economic and social burdens upon hospital discharge.

Similares en LA Referencia