Less invasive stabilisation system (LISS) for the treatment of periprosthetic femoral fractures: A 3-year follow-up
Introduction
A successful joint replacement may be compromised by a periprosthetic fracture. With increasing numbers of joint replacements, the prevalence of periprosthetic fractures is on the rise and estimated to range from 0.1 to 2.5%.3, 7, 20, 23, 28, 30
Multiple morbidities, including generalised osteoporosis, are usually found in this patient population and emphasise the importance of individual and precise therapeutic planning. Various treatment options exist for these injuries. In general, results have been inconsistent and complication rates of 25–75% have been reported.1, 3, 5, 9, 14, 22, 23, 24, 29 In a meta-analysis of 195 periprosthetic fractures the complication rate averaged 30%.5
Recent authors have reported encouraging results with the internal fixator LISS in the management of periprosthetic femoral fractures in terms of applicability, operative time and complications.2, 12, 15, 16, 18, 26, 29 However, data on mid- and long-term functional outcome is not available.
The aim of this study was to determine whether the promising reported results of the LISS are associated with a satisfying mid-term functional outcome. We therefore determined the functional outcome for a cohort of patients (n = 16) at a 3-year follow-up who had been managed with the LIS-System for periprosthetic femoral fractures.
Section snippets
Follow-up
The follow-up for this study was performed after a mean of 34 months. The clinical outcome was measured with the use of the Karnofsky activity index6 (Table 1) and the Harris Hip score.13 All patients had initially been seen as a result of an acute periprosthetic fracture and therefore no preoperative Karnofsky activity index or Harris Hip score had been obtained.
Anteroposterior and lateral radiographs of the involved femur were taken and compared to postoperative radiographs to assess bone
Results
From 1998 to 2001 we managed 21 patients with periprosthetic fractures with the LIS-System. These included 16 women and 5 men with a mean age of 78 years at the time of injury. Of the 21 patients primarily included, 2 were lost for follow-up and 3 patients died from causes unrelated to surgery. A summary of patient data and results is shown in Table 3.
Discussion
Periprosthetic fractures after total hip replacement represent serious complications and are difficult to treat. In this study we analysed the complications and mid-term functional outcome of periprosthetic fractures stabilised with the internal fixator LISS. In these cases the LISS proved to be an implant associated with low complication rates and good functional outcome.
The assessment of a successful periprosthetic fracture treatment is difficult. On the one hand the patient population
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2020, Orthopaedics and TraumaCitation Excerpt :The standard method of fixation for these is the minimally invasive plate osteosynthesis (MIPO) technique. Good results have been reported using the locking compression plate (LCP) and the less invasive stabilization system (LISS).13,14 A variety of plates are available to fix these fractures.
Osteosynthesis of periprosthetic type A and B femoral fractures using an unlocked plate with integrated cerclage cable and trochanteric hook: A multicenter retrospective study of 45 patients with mean follow-up of 20 months
2017, InjuryCitation Excerpt :Publications report several osteosynthesis techniques: by direct or minimally invasive approach, locked or unlocked plate. The results and findings are variable [12–30]. Biomechanical studies show that proximal mono cortical and distal bi cortical screw fixations or proximal cerclage and distal bi cortical screw fixations ensure good stabilization in axial compression, lateral compression in 4 points (anterior-posterior and medio-lateral) and in torsion [31–33].
Locking plate fixation for Vancouver B1 periprosthetic femoral fractures: A critical analysis of 135 cases
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2012, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :A possible explanation might be the surgical technique and smaller accompanying soft tissue trauma too. However, the presented data shows definitely lower complication rates for NCB®-plating compared to conventional plate osteosynthesis [6,18,31,32]. Comparing it to analogue locking plate systems with monoaxial stability, a similar complication and revision rate between 5.2 and 27% is detected.