1. Immediate weightbearing is safe after revision total hip arthroplasty for Vancouver B2/B3 periprosthetic femur fractures.
- Author
-
Gopinath, Rohan, Oster, Brittany A., Mixa, Patrick J., Costales, Timothy G., Johnson, Aaron J., and Manson, Theodore T.
- Subjects
- *
TOTAL hip replacement , *PERIPROSTHETIC fractures , *FEMORAL fractures , *HEMIARTHROPLASTY , *SURVIVAL analysis (Biometry) , *LAND subsidence - Abstract
• Modular fluted tapered stems are reliably used for the treatment of Vancouver b fractures. • Historically, these patients had weightbearing restrictions postoperatively. • We examined stem subsidence and mortality in patients who were allowed to immediately weight bear compared to those made non-weightbearing. • There was no difference in subsidence rate between the WBAT and NWB cohort. • Earlier weightbearing was also associated with trends toward improved all-cause mortality rates at one-year postoperatively. Modular fluted, tapered stems provide a reliable treatment for Vancouver B2/B3 fractures. Historically, these patients had weightbearing restrictions postoperatively. Although full immediate postoperative weightbearing may provide benefits in this patient population, stem subsidence is a concern. The objective of this study was to investigate the effect of post-operative weight-bearing status on stem subsidence in patients treated with modular tapered stems for Vancouver B2 and B3 periprosthetic fractures. We sought to answer two questions: (1) Does full immediate postoperative weightbearing after revision total hip arthroplasty for periprosthetic femur fracture lead to increased stem subsidence compared to protected weightbearing? (2) Is there a mortality difference between these two groups of patients with different weightbearing restrictions? From 2009 to 2015 all patients who underwent revision for Vancouver B2/B3 fractures were made non-weightbearing (NWB) for six weeks postoperatively. After 2015, immediate weightbearing as tolerated (WBAT) was allowed postoperatively. We compared stem subsidence between immediate postoperative and final radiographs. Additionally, we performed a Kaplan-Meijer analysis with one-year mortality as an endpoint. The final cohort included forty-seven patients with an average follow-up of 254 days. The average stem subsidence was 1.0 mm (95 % CI, 0.5–1.5 mm) in the NWB cohort and 0.3 mm (95 % CI, 0–0.7 mm) in the WBAT cohort (P = 0.10). In our survivorship analysis, we noted no deaths in the WBAT cohort compared to 17 % mortality in the NWB cohort at the one-year timepoint. Allowing patients to weight bear immediately after revision does not increase stem subsidence. Further studies are needed to determine whether early weightbearing provides a mortality benefit. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF