학술논문
The characteristics and predictors of mortality in periprosthetic fractures around the knee.
Document Type
Academic Journal
Author
Nasser AAHH; The Birmingham Orthopaedic Network, The Royal Orthopaedic Hospital, Birmingham, UK.; Sidhu M; The Birmingham Orthopaedic Network, The Royal Orthopaedic Hospital, Birmingham, UK.; Prakash R; The Birmingham Orthopaedic Network, The Royal Orthopaedic Hospital, Birmingham, UK.; Mahmood A; Trauma and Orthopaedics, Queen Elizabeth Hospital, Birmingham, UK.; Osman K; The Birmingham Orthopaedic Network, The Royal Orthopaedic Hospital, Birmingham, UK.; Chauhan GS; The Birmingham Orthopaedic Network, The Royal Orthopaedic Hospital, Birmingham, UK.; Nandra R; The Birmingham Orthopaedic Network, The Royal Orthopaedic Hospital, Birmingham, UK.; Dewan V; The Birmingham Orthopaedic Network, The Royal Orthopaedic Hospital, Birmingham, UK.; Davidson J; St Thomas Hospital, London, UK.; Al-Azzawi M; St Thomas Hospital, London, UK.; Smith C; St Thomas Hospital, London, UK.; Gawad M; St Thomas Hospital, London, UK.; Palaiologos I; The Whittington Hospital, London, UK.; Cuthbert R; The Whittington Hospital, London, UK.; Wignadasan W; The Whittington Hospital, London, UK.; Banks D; New Cross Hospital, Wolverhampton, UK.; Archer J; New Cross Hospital, Wolverhampton, UK.; Odeh A; New Cross Hospital, Wolverhampton, UK.; Moores T; Walsall Manor Hospital, Walsall, UK.; Tahir M; Walsall Manor Hospital, Walsall, UK.; Brooks M; Walsall Manor Hospital, Walsall, UK.; Biring G; Stoke Mandeville Hospital, Aylesbury, UK.; Jordan S; Stoke Mandeville Hospital, Aylesbury, UK.; Elahi Z; Stoke Mandeville Hospital, Aylesbury, UK.; Shaath M; Stoke Mandeville Hospital, Aylesbury, UK.; Veettil M; Sandwell General Hospital, West Bromwich, UK.; De C; Sandwell General Hospital, West Bromwich, UK.; Handford C; Sandwell General Hospital, West Bromwich, UK.; Bansal M; Princess Royal University Hospital, Orpington, UK.; Bawa A; Princess Royal University Hospital, Orpington, UK.; Mattar A; Princess Royal University Hospital, Orpington, UK.; Tandra V; Princess Royal University Hospital, Orpington, UK.; Daadipour A; Princess Royal University Hospital, Orpington, UK.; Taha A; Princess Royal University Hospital, Orpington, UK.; Gangoo S; James Paget Hospital, Norfolk, UK.; Srinivasan S; James Paget Hospital, Norfolk, UK.; Tarisai M; James Paget Hospital, Norfolk, UK.; Budair B; Queen Elizabeth Hospital, Birmingham, UK.; Subbaraman K; Queen Elizabeth Hospital, Birmingham, UK.; Khan F; Queen Elizabeth Hospital, Birmingham, UK.; Gomindes A; Queen Elizabeth Hospital, Birmingham, UK.; Samuel A; Queen Elizabeth Hospital, Birmingham, UK.; Kang N; Addenbrooke's Hospital, Cambridge, UK.; Kapur K; Addenbrooke's Hospital, Cambridge, UK.; Mainwaring E; Addenbrooke's Hospital, Cambridge, UK.; Bridgwater H; Addenbrooke's Hospital, Cambridge, UK.; Lo A; Addenbrooke's Hospital, Cambridge, UK.; Ahmed U; Princess Royal Hospital, Telford, UK.; Khaleeq T; Princess Royal Hospital, Telford, UK.; El-Bakoury A; Derriford Hospital, Plymouth, UK.; Rashed R; Derriford Hospital, Plymouth, UK.; Hosny H; Derriford Hospital, Plymouth, UK.; Yarlagadda R; Derriford Hospital, Plymouth, UK.; Keenan J; Derriford Hospital, Plymouth, UK.; Hamed A; Derriford Hospital, Plymouth, UK.; Riemer B; University Hospital Coventry & Warwickshire, Coventry, UK.; Qureshi A; University Hospital Coventry & Warwickshire, Coventry, UK.; Gupta V; University Hospital Coventry & Warwickshire, Coventry, UK.; Waites M; Russell's Hall Hospital, Dudley, UK.; Bleibleh S; Russell's Hall Hospital, Dudley, UK.; Westacott D; Russell's Hall Hospital, Dudley, UK.; Phillips J; Royal Devon and Exeter Hospital, Exeter, UK.; East J; Royal Devon and Exeter Hospital, Exeter, UK.; Huntley D; Royal Devon and Exeter Hospital, Exeter, UK.; Masud S; Morriston Hospital, Swansea, UK.; Mirza Y; Morriston Hospital, Swansea, UK.; Mishra S; Morriston Hospital, Swansea, UK.; Dunlop D; Royal Orthopaedic Hospital, Birmingham, UK.; Khalefa M; Royal Orthopaedic Hospital, Birmingham, UK.; Balakumar B; Royal Orthopaedic Hospital, Birmingham, UK.; Thibbaiah M; Royal Orthopaedic Hospital, Birmingham, UK.; Payton O; Royal Orthopaedic Hospital, Birmingham, UK.; Berstock J; Royal United Hospital, Bath, UK.; Deano K; Royal United Hospital, Bath, UK.; Sarraf KM; St Mary's Hospital, London, UK.; Logishetty K; St Mary's Hospital, London, UK.; Lee G; St Mary's Hospital, London, UK.; Subbiah-Ponniah H; St Mary's Hospital, London, UK.; Shah N; Worthing Hospital, Worthing, UK.; Venkatesan A; Worthing Hospital, Worthing, UK.; Cheseldene-Culley J; Worthing Hospital, Worthing, UK.; Ayathamattam J; Worthing Hospital, Worthing, UK.; Ealing Hospital, Southall, UK.; Tross S; Ealing Hospital, Southall, UK.; Randhawa S; Ealing Hospital, Southall, UK.; Mohammed F; Ealing Hospital, Southall, UK.; Ali R; Ealing Hospital, Southall, UK.; Bird J; University Hospital Lewisham, London, UK.; Khan K; University Hospital Lewisham, London, UK.; Akhtar MA; Victoria Hospital, Kirkcaldy, UK.; Brunt A; Victoria Hospital, Kirkcaldy, UK.; Roupakiotis P; Victoria Hospital, Kirkcaldy, UK.; Subramanian P; Barnet General Hospital, Barnet, UK.; Bua N; Barnet General Hospital, Barnet, UK.; Hakimi M; Salford Royal Hospital, Salford, UK.; Bitar S; Salford Royal Hospital, Salford, UK.; Al Najjar M; Salford Royal Hospital, Salford, UK.; Radhakrishnan A; Salford Royal Hospital, Salford, UK.; Gamble C; Salford Royal Hospital, Salford, UK.; James A; Ulster Hospital, Belfast, UK.; Gilmore C; Ulster Hospital, Belfast, UK.; Dawson D; Ulster Hospital, Belfast, UK.; Sofat R; Lister Hospital, Stevenage, UK.; Antar M; Lister Hospital, Stevenage, UK.; Raghu A; Lister Hospital, Stevenage, UK.; Heaton S; Yeovil District Hospital, Yeovil, UK.; Tawfeek W; Yeovil District Hospital, Yeovil, UK.; Charles C; Yeovil District Hospital, Yeovil, UK.; Burnand H; Bristol Royal Infirmary, Bristol, UK.; Duffy S; Bristol Royal Infirmary, Bristol, UK.; Taylor L; Bristol Royal Infirmary, Bristol, UK.; Magill L; The Birmingham Centre for Observational and Prospective Studies (BiCOPS), University of Birmingham, Birmingham, UK.; Perry R; The Birmingham Centre for Observational and Prospective Studies (BiCOPS), University of Birmingham, Birmingham, UK.; Pettitt M; The Birmingham Centre for Observational and Prospective Studies (BiCOPS), University of Birmingham, Birmingham, UK.; Okoth K; The Birmingham Centre for Observational and Prospective Studies (BiCOPS), University of Birmingham, Birmingham, UK.; Pinkney T; The Birmingham Centre for Observational and Prospective Studies (BiCOPS), University of Birmingham, Birmingham, UK.
Source
Publisher: British Editorial Society of Bone & Joint Surgery Country of Publication: England NLM ID: 101599229 Publication Model: Electronic Cited Medium: Internet ISSN: 2049-4408 (Electronic) Linking ISSN: 20494394 NLM ISO Abbreviation: Bone Joint J Subsets: MEDLINE
Subject
Language
English
Abstract
Aims: Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality.
Methods: Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality.
Results: Out of a total of 1,667 patients in the PPF study database, 420 patients were included. The in-hospital mortality rate was 6.4%. Multivariable analyses suggested that American Society of Anesthesiologists (ASA) grade, history of peripheral vascular disease (PVD), history of rheumatic disease, fracture around a loose implant, and cerebrovascular accident (CVA) during hospital stay were each independently associated with mortality. Each point increase in ASA grade independently correlated with a four-fold greater mortality risk (odds ratio (OR) 4.1 (95% confidence interval (CI) 1.19 to 14.06); p = 0.026). Patients with PVD have a nine-fold increase in mortality risk (OR 9.1 (95% CI 1.25 to 66.47); p = 0.030) and patients with rheumatic disease have a 6.8-fold increase in mortality risk (OR 6.8 (95% CI 1.32 to 34.68); p = 0.022). Patients with a fracture around a loose implant (Unified Classification System (UCS) B2) have a 20-fold increase in mortality, compared to UCS A1 (OR 20.9 (95% CI 1.61 to 271.38); p = 0.020). Mode of management was not a significant predictor of mortality. Patients managed with revision arthroplasty had a significantly longer length of stay (median 16 days; p = 0.029) and higher rates of return to theatre, compared to patients treated nonoperatively or with fixation.
Conclusion: The mortality rate in PPFs around the knee is similar to that for native distal femur and neck of femur fragility fractures. Patients with certain modifiable risk factors should be optimized. A national PPF database and standardized management guidelines are currently required to understand these complex injuries and to improve patient outcomes.
Competing Interests: A. A. H. H. Nasser and A. Mahmood report funding from Queen Elizabeth Hospital Birmingham Charity Trauma Research and Education Fund, related to this study.
(© 2024 The British Editorial Society of Bone & Joint Surgery.)
Methods: Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality.
Results: Out of a total of 1,667 patients in the PPF study database, 420 patients were included. The in-hospital mortality rate was 6.4%. Multivariable analyses suggested that American Society of Anesthesiologists (ASA) grade, history of peripheral vascular disease (PVD), history of rheumatic disease, fracture around a loose implant, and cerebrovascular accident (CVA) during hospital stay were each independently associated with mortality. Each point increase in ASA grade independently correlated with a four-fold greater mortality risk (odds ratio (OR) 4.1 (95% confidence interval (CI) 1.19 to 14.06); p = 0.026). Patients with PVD have a nine-fold increase in mortality risk (OR 9.1 (95% CI 1.25 to 66.47); p = 0.030) and patients with rheumatic disease have a 6.8-fold increase in mortality risk (OR 6.8 (95% CI 1.32 to 34.68); p = 0.022). Patients with a fracture around a loose implant (Unified Classification System (UCS) B2) have a 20-fold increase in mortality, compared to UCS A1 (OR 20.9 (95% CI 1.61 to 271.38); p = 0.020). Mode of management was not a significant predictor of mortality. Patients managed with revision arthroplasty had a significantly longer length of stay (median 16 days; p = 0.029) and higher rates of return to theatre, compared to patients treated nonoperatively or with fixation.
Conclusion: The mortality rate in PPFs around the knee is similar to that for native distal femur and neck of femur fragility fractures. Patients with certain modifiable risk factors should be optimized. A national PPF database and standardized management guidelines are currently required to understand these complex injuries and to improve patient outcomes.
Competing Interests: A. A. H. H. Nasser and A. Mahmood report funding from Queen Elizabeth Hospital Birmingham Charity Trauma Research and Education Fund, related to this study.
(© 2024 The British Editorial Society of Bone & Joint Surgery.)