title: Has a patient type with peri-prosthetic femoral fractures evolved?
abstract: OBJECTIVE
  Peri-prosthetic fractures (PPF) have been showing a constant increase. The typical patient described in the SOFCOT symposium in 2005 with PPF was an elderly 77-year-old woman with hip athroplasty (HA). The purpose of this study was to actualize the characteristics of this population. Our hypothesis is that patient type remains a female, but much older, with an equal distribution between HA and knee arthroplasty (KA).
  
  
  METHODS
  All cases of PPF were retrospectively gathered during an 18 month period. Besides regular epidemiologic data, we noted autonomy level (Parker, Devane), residence and dependence (Katz), the type of implant, of fracture, the severity of fracture, the onset and the state of solidity of the prosthesis.
  
  
  RESULTS
  The series consisted of 81 patients (58 F, 23 M) (81 fractures), mean age of 82.2 years; 3.5% of them were admits from the emergency admits; and 69.1% lived at home. Parker's mean score was 4.6, Devane's mean score was 1.8 and Katz's mean score was 4.2. There were totals of 46 HA fractures and 39 total knee arthroplasty (TKA) of which four were inter-prosthetic and three were either KA or proximal osteosynthesis. Onset before fracture for HA was 12.1 years, 7.9 years for KA, and 10.2 years for all series. Patients were younger for HA (80.8 years) than for KA (84.1 years). The fracture was mostly noticed in the third proximal (49.4%), spiral segment (44.5%) and around the implant, while 34.8% of loosening was observed for HA versus 7.7% for KA.
  
  
  CONCLUSIONS
  The patient type has evolved confirming our hypothesis: they are always a female more than 82 years old with a number of fractures on KA similar to that of HA. The patients lived at home, had some autonomy, were somewhat independent in their daily activities but sedentary. Fractures were mostly on the third proximal femur, spiral segment and around the implant. PPF remains rare and a theoretical increase is yet to be confirmed.
  
  
  METHODS
  prospective study type IV, cohort study.
authors.affiliation: Service de Chirurgie Orthopédique et de Traumatologie, CHU Hautepierre, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg Cedex, France, matthieu.ehlinger@chru-strasbourg.fr.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Ehlinger
authors.forename: David
authors.initials: D
authors.lastname: Bahlau
authors.forename: Michel
authors.initials: M
authors.lastname: Rahme
authors.forename: Philippe
authors.initials: P
authors.lastname: Adam
authors.forename: François
authors.initials: F
authors.lastname: Bonnomet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology* / Q000601:surgery; D005593:Fracture Fixation, Internal; D006621:Hip Joint / Q000601:surgery*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000453:epidemiology*; D011446:Prospective Studies