OBB-0009

Patient reported outcomes following operative management of type B periprosthetic femoral fractures around cemented femoral components.


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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:

  1. Retrospective cohort study of operatively managed patients from the past 5 years at the lead center
  2. 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.

  1. Yasen AT, Haddad FS. Periprosthetic fractures: bespoke solutions. Bone Joint J. 2014 Nov;96-B(11 Supple A):48–55.
  2. 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.
  3. 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.
  4. Brady OH, Garbuz DS, Masri BA, Duncan CP. Classification of the hip. Orthopedic Clinics of North America. 1999 Apr;30(2):215–20.
  5. 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.
  6. 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.
  7. 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.

 



Purpose of the research and originality(Required)

Other documents

Applicant CV: Download here
Reference letter: Download here