Frank Stinchfield Award: Creation of a Patient-Specific Total Hip Arthroplasty Periprosthetic Fracture Risk Calculator.
Frank Stinchfield Award: Creation of a Patient-Specific Total Hip Arthroplasty Periprosthetic Fracture Risk Calculator.
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Frank Stinchfield 奖：创建针对患者的全髋关节置换术假体周围骨折风险计算器。
DOI：
10.1016/j.arth.2023.03.031
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Abdel,MatthewP
中科院分区：
文献类型：
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作者：
Wyles,CodyC;Maradit-Kremers,Hilal;Fruth,KristinM;Larson,DirkR;Khosravi,Bardia;Rouzrokh,Pouria;Johnson,QuinnJ;Berry,DanielJ;Sierra,RafaelJ;Taunton,MichaelJ;Abdel,MatthewP
研究背景人工全髋关节置换术后股骨假体周围骨折(PPFFx)的危险因素很多，但仍缺乏针对患者的风险评估工具。这项研究的目的是开发一个高维的、特定于患者的风险分层诺模图，允许根据手术决策进行动态风险修改。方法我们评估了1998至2018年间进行的16,696例原发非肿瘤性THA。在平均6年的随访中，558名患者(3.3%)持续了PPFFx。患者的特点是在个人自然语言处理辅助下对不可修改的因素(人口统计学、全髋关节适应症和合并症)和可修改的手术决定(股骨固定[骨水泥/非骨水泥]，手术入路[直接前、侧和后方]，以及植入类型[有领/无领])进行图表回顾。以术后90天、1年和5年的PPFFx为二项指标，建立多变量Cox回归模型和诺模图。结果基于共病分布的患者的PPFFx风险在90天为0.4-18%，1年为0.4%-20%，5年为0.5%-25%。在18个被评估的患者因素中，7个被保留在多变量分析中。4个不可修改的显著因素包括：女性(危险比(HR)=1.6)，高龄(HR=1.2每10年)，诊断为骨质疏松或使用骨质疏松药物(HR=1.7)，以及骨性关节炎以外的手术适应症(HR=2.2骨折，HR=1.8炎性关节炎，HR=1.7骨坏死)。3个可修改的手术因素包括：非骨水泥股骨内固定(HR=2.5)、无环股骨内固定物(HR=1.3)和非直接前入路(外侧HR=2.9，后方HR=1.9)。结论这种患者特有的PPFFx风险计算器基于共病情况显示了广泛的风险，使外科医生能够根据手术决策量化风险缓解。
BackgroundMany risk factors have been described for periprosthetic femur fracture (PPFFx) following total hip arthroplasty (THA), yet a patient-specific risk assessment tool remains elusive. The purpose of this study was to develop a high-dimensional, patient-specific risk-stratification nomogram that allows dynamic risk modification based on operative decisions.MethodsWe evaluated 16,696 primary nononcologic THAs performed between 1998 and 2018. During a mean 6-year follow-up, 558 patients (3.3%) sustained a PPFFx. Patients were characterized by individual natural language processing-assisted chart review on nonmodifiable factors (demographics, THA indication, and comorbidities), and modifiable operative decisions (femoral fixation [cemented/uncemented], surgical approach [direct anterior, lateral, and posterior], and implant type [collared/collarless]). Multivariable Cox regression models and nomograms were developed with PPFFx as a binary outcome at 90 days, 1 year, and 5 years, postoperatively.ResultsPatient-specific PPFFx risk based on comorbid profile was wide-ranging from 0.4-18% at 90 days, 0.4%-20% at 1 year, and 0.5%-25% at 5 years. Among 18 evaluated patient factors, 7 were retained in multivariable analyses. The 4 significant nonmodifiable factors included the following: women (hazard ratio (HR) = 1.6), older age (HR = 1.2 per 10 years), diagnosis of osteoporosis or use of osteoporosis medications (HR = 1.7), and indication for surgery other than osteoarthritis (HR = 2.2 for fracture, HR = 1.8 for inflammatory arthritis, HR = 1.7 for osteonecrosis). The 3 modifiable surgical factors were included as follows: uncemented femoral fixation (HR = 2.5), collarless femoral implants (HR = 1.3), and surgical approach other than direct anterior (lateral HR = 2.9, posterior HR = 1.9).ConclusionThis patient-specific PPFFx risk calculator demonstrated a wide-ranging risk based on comorbid profile and enables surgeons to quantify risk mitigation based on operative decisions.Level of EvidenceLevel III, Prognostic.