Risk Factors Associated With Femorotomy or Fracture During Cementless Stem Removal and Generation of an Individual Predictive Risk Score,The Journal of Arthroplasty

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Risk Factors Associated With Femorotomy or Fracture During Cementless Stem Removal and Generation of an Individual Predictive Risk Score
The Journal of Arthroplasty ( IF 3.4 ) Pub Date : 2022-09-16 , DOI: 10.1016/j.arth.2022.09.012
Thomas Aubert ₁ , Guillaume Auberger ₁ , Philippe Gerard ₁ , Luc Lhotellier ₁ , Simon Marmor ₁ , Wilfrid Graff ₁

Affiliation

Femorotomy is a commonly used technique during cementless stem removal but should be preferred in selective revision cases to prevent intraoperative femoral fracture associated with deteriorated clinical outcome. Our aim was to assess the risk factors for fracture or femorotomy and develop a predictive risk stratification score. A monocentric retrospective cohort including 202 patients was analyzed. Thirty six candidate prognostic factors were assessed. The following independent predictors of fracture or femorotomy were identified: presence of a “bracket sign” (Odds Ratio [OR]: 10.857; 95% Confidence interval [CI]: 2.613-45.115; = .001) defined as a distal spot weld between the surface of the implant and closest endosteum, bone contact in zone 2 (OR: 4.700; 95% CI: 1.827-12.089; = .001), 6 (OR: 4.966; 95% CI: 1.823-13.530; = .002), 12 (OR: 9.660; 95% CI: 3.715-25.116; < .0001), 13 (OR: 2.958; 95% CI: 1.009-8.021; = .033), and global hypertrophy (OR: 0.170; 95% CI: 0.036-0.806; = .026). The prognostic score, named Femorotomy INcidence Numeric scoring system, had good performance and discriminability; the area under the curve of the model was 0.924 (95% CI: 0.878-0.969). The only independent risk factors were those assessed on X-ray (eg, bracket sign, bone contact in zones 2, 6, 12, and 13), while global hypertrophy was protective. We noticed the importance of differentiating pedestals and “bracket signs”; the latter is an indicator of fixation of the stem. We developed a risk prediction score (Femorotomy INcidence Numeric score) of fracture or femorotomy that can be used as a companion tool to assess the risk for doing an early osteotomy of the femur.

中文翻译：

非骨水泥柄切除过程中与股骨切开术或骨折相关的风险因素以及个人预测风险评分的生成

股骨切开术是非骨水泥股骨柄移除过程中常用的技术，但在选择性翻修病例中应首选，以防止术中股骨骨折与临床结果恶化相关。我们的目的是评估骨折或股骨切开术的风险因素并制定预测风险分层评分。对包括 202 名患者的单中心回顾性队列进行了分析。评估了 36 个候选预后因素。确定了骨折或股骨切开术的以下独立预测因素：存在“括号标志”（优势比 [OR]：10.857；95% 置信区间 [CI]：2.613-45.115；= 0.001），定义为之间的远端点焊种植体表面和最近的骨内膜，骨接触区域 2（OR：4.700；95% CI：1.827-12.089；= .001）、6（OR：4.966；95% CI：1.823-13.530；= .002）、12（OR：9.660；95% CI：3.715-25.116；< .0001）、13（OR：2.958；95% CI：1.009-8.021；= .033）和整体肥大（OR：0.170；95% CI ：0.036-0.806；= .026)。预后评分为Femorotomy INcidence Numeric评分系统，具有良好的性能和区分性；模型曲线下面积为 0.924 (95% CI: 0.878-0.969)。唯一的独立危险因素是 X 射线评估的因素（例如，支架征、2、6、12 和 13 区的骨接触），而整体肥大具有保护性。我们注意到区分基座和“支架标志”的重要性；后者是阀杆固定的指标。我们开发了骨折或股骨切开术的风险预测评分（股骨切开术发生数字评分），可用作评估股骨早期截骨术风险的配套工具。

更新日期：2022-09-16

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