Mars, R.C. (Riemke) (2014) Invloed van kwetsbaarheid op de uitkomst van verschillende chirurgische behandelingen bij periprothetische fracturen van het femur. thesis, Medicine.
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Abstract
Introduction A postoperative periprosthetic fracture (PPF) is a serious long-term complication of a total hip replacement, which often occurs in the elderly. There are several treatment options such as revision, open reduction and internal fixation (ORIF) and placing a retrograde intramedullary femoral nail. In the current guiding lines for choosing the best treatment, the level of frailty of the patient is not taking into consideration in this relatively old population. The aim of this study is to determine whether a frail patient has a better outcome postoperatively after receiving less invasive treatment for a PPF. Material and Methods 49 patients (of whom 32 are frail) with a PPF between 2009 and 2013 were analyzed. The level of frailty was obtained by the periprosthetic fracture frailty index (PPFFI). Primary outcomes in this study are mortality, minor complications and three major complications (deceased within 1 year, re-operation within 1 year and inability to walk after 1 year). Secondary outcome is amount of days admitted in the hospital. Results We have confirmed that frail patients suffer from more major complications (p=0.017) and have a lower survival rate than non-frail patients. Furthermore we have found significantly more minor complications in revision than ORIF and placing an intramedullar nail. Lastly we found that frail patients with a PPF who were treated with revision compared to ORIF or an intramedullar nail suffered from more minor complications (p=0.005 and 0.000) and were admitted in the hospital for more days (p=0.05 and 0.003). Conclusion This study shows that frail patients regardless the type of surgery have a lower survival rate. This paper also shows that in frail patients with a periprosthetic fracture the severity of the operation has a negative influence on the outcome of the treatment. Therefore it is of great importance to establish the level of frailty and take this into consideration in determining the treatment for periprosthetic fractures.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Zuurmond, dr. R.G. and Isala klinieken, Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:49 |
| Last Modified: | 25 Jun 2020 10:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1057 |
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