OBB-0009
Section 1 - Basic information about you and your application:
Title of research project
Patient reported outcomes following operative management of type B periprosthetic femoral fractures around cemented femoral components.
Project summary
Periprosthetic femoral fractures (PFFs) are serious and increasingly common complications which can occur following total hip arthroplasty. In practice there is significant variation in operative management and minimal data on patient reported outcomes. The aim of this project is to evaluate patient reported outcomes following operative management of type B PFFs around cemented femoral components. This will be achieved through 1) a retrospective cohort study of operatively managed patients from the past 5 years at the lead center 2) a pilot prospective cohort study of all periprosthetic femoral fractures managed at the lead center. The results of this study will not only provide a holistic view of patient outcomes but will also determine the feasibility of a multicentre prospective cohort study of PPFs. Ultimately the aim is to perform a cost-effectiveness study of revision versus fixation for PPFs around cemented stems.
Type of project
Research
Type of research
Clinical
Specialty/Area:
Orthopaedic Trauma/ Recon
Start date
01/12/2023
End date
01/05/2024
Section 2 - Purpose of the research and originality
Aims / Objectives:
The aim of this study is to evaluate patient reported outcomes following operative management of type B PFFs around cemented femoral components. It has 2 parts:
- Retrospective cohort study of operatively managed patients from the past 5 years at the lead center
- Pilot Prospective cohort study of all periprosthetic femoral fractures managed at the lead center
If patients can be successfully prospectively recruited at the study center, this pilot study will determine the feasibility of a multicentre prospective cohort study of PPFs, initially open to other centers across the UK who have previously been involved in this collaborative PPF study group. The ultimate aim is to perform a cost-effectiveness study of revision versus fixation for PPFs around cemented stems.
Background to investigation:
Periprosthetic femoral fracture (PFF) is a serious and increasingly common complication which can occur following total hip arthroplasty. The management is complex, and patients often have several co-morbidities (1). PFFs are not only associated with morbidity and mortality but also significant burden on health systems (2). This burden is only expected to increase in the coming years, with the incidence of PFFs rising by 13% each year (3) .
The Vancouver system which classifies PFFs based on location and stability is widely used to guide decisions surrounding operative management (4). Open reduction internal fixation (ORIF) can be used to treat B1 fractures whereas revision arthroplasty is recommended for B2 and B3 fractures (5). However, there is a lack of clear evidence surrounding the optimal management of type B fractures around cemented femoral components. Consequently, in practice there is significant variation in management with no clear consensus regarding ORIF vs revision arthroplasty (6).
Although several studies (6,7) have evaluated the outcomes of ORIF and revision arthroplasty for type B PFFs, there remains a need for prospective studies and a more comprehensive evaluation of patient outcomes. This study will add to the existing evidence and provide a more holistic view through an evaluation of patient reported outcome measures (PROMs) following PFF.
- Yasen AT, Haddad FS. Periprosthetic fractures: bespoke solutions. Bone Joint J. 2014 Nov;96-B(11 Supple A):48–55.
- Shields E, Behrend C, Bair J, Cram P, Kates S. Mortality and Financial Burden of Periprosthetic Fractures of the Femur. Geriatr Orthop Surg Rehabil. 2014 Dec 20;5(4):147–53.
- Bottle A, Griffiths R, White S, Wynn-Jones H, Aylin P, Moppett I, et al. Periprosthetic fractures: the next fragility fracture epidemic? A national observational study. BMJ Open. 2020 Dec 10;10(12):e042371.
- Brady OH, Garbuz DS, Masri BA, Duncan CP. Classification of the hip. Orthopedic Clinics of North America. 1999 Apr;30(2):215–20.
- Greidanus N V, Mitchell PA, Masri BA, Garbuz DS, Duncan CP. Principles of management and results of treating the fractured femur during and after total hip arthroplasty. Instr Course Lect. 2003;52:309–22.
- Powell-Bowns MFR, Oag E, Ng N, Pandit H, Moran M, Patton JT, et al. Vancouver B periprosthetic fractures involving the Exeter cemented stem. Bone Joint J. 2021 Feb;103-B(2):309–20.
- Jain S, Farook MZ, Aslam-Pervez N, Amer M, Martin DH, Unnithan A, et al. A multicentre comparative analysis of fixation versus revision surgery for periprosthetic femoral fractures following total hip arthroplasty with a cemented polished taper-slip femoral component. Bone Joint J. 2023 Feb;105-B(2):124–34.
Section 3 - Plan of investigation
Plan of investigation:
This study will evaluate patient reported outcomes in operatively managed patients with type B PFFs around cemented femoral components.
PROMs would consist of EQ-5D (Health Related Quality of Life), LEFS (Lower Extremity Function Score) and Oxford Hip Scores (OHS). These are validated general health and joint specific scores appropriate for use in older adults after lower limb fracture. These will be applied to all new patients with periprosthetic femoral fractures being treated at the lead center which is a large tertiary referral University Hospital that treats ~100 PPFs per year. Patients will then be followed up at 6 and 12 months and PROMs applied again.
In addition to this prospective cohort, patients who have undergone operative management at the lead center in the past 5 years will be identified from a prospectively followed trauma database. Radiographic analysis and classification according to the Vancouver system will be performed to identify type B PFFs. Demographic and other relevant information will be obtained from the database and electronic medical records.
The primary outcome measure will be the difference in HRQoL between the ORIF cohort and the revision arthroplasty cohort. Procedure costs will be calculated using length of hospital stay, implant costs and readmissions. Limb and joint specific scores as per LEFS and OHS will also be compared. Propensity score matching will allow for a meaningful comparison of the two groups. Statistical analysis will be performed in R studio.
Section 4 - Research impact and benefits
Research impact and benefits:
The opportunity to carry out this research with help of the OBB research fund will allow me to develop a strong foundation of knowledge and skills which are vital for an academic career in orthopedic surgery. Support from the OBB research fund will enable me to take on a leading role in a research project and therefore allow me to apply the principles taught in the BOMSA/BOTA/ORUK Research Webinar Series. Additionally, I will gain a deeper understanding of evidence-based medicine and the importance of patient centered care.
In addition to helping me build a strong foundation of research skills, this project will also provide me with an opportunity work alongside and gain mentorship from experts in the field. These connections will be instrumental in the process of starting an academic career. Ultimately, this project will help me to work towards my long-term goal of an academic career in orthopedic surgery.
The proposed study which focuses on patient reported outcomes requires questionnaires to be mailed across the UK. The OBB research funding will be used to cover the cost associated with sending out questionnaires. The funding will also be put towards presenting at a conference.
Section 5 - Strength of individual and achievements to aid facilitate the project?
Name:
Ms. Abigail (Abbey) Bowley
Institution:
The University of Edinburgh / The University of Edinburgh
Year of study / grade / job title:
6th Year Medical Student
Graduation date:
01/05/2024
Are you undertaking this project as part of an intercalated degree?
No
Does your institution offer an intercalated degree option?
Yes
Role
Abbey will take on a leading role in every step of this project. This includes the project proposal, identification of patients, mailing of questionnaires, data analysis and manuscript writing. In the role of supervisor Ms. Chloe Scott will oversee the entire study and provide expert guidance and assistance where needed.
Supervisor name
Chloe Scott
Supervisor job title
Consultant Orthopaedic Surgeon
Supervisor address
Royal Infirmary of Edinburgh 51 Little France Cres, Old Dalkeith Rd, Edinburgh, Lothian EH16 4SA, GB
Applicant reference
Chloe Scott
Other documents
Applicant CV: Download hereReference letter: Download here