Postoperative load bearing in periprosthetic femoral fractures: A survey among orthopedic surgeons in the Netherlands

Abstract text (incl. references and figure legends)

Introduction: Permissive weightbearing (PWB) has relatively recently been implemented to optimize rapid clinical recovery and restoration of function in patients suffering lower extremity fractures. PWB shows outcome advantages in this patient category. Currently there is no consensus on postoperative load bearing management after surgically treated periprosthetic femoral fractures (PPFF). The objective is to investigate the current postoperative practice of weightbearing instructions for patients with surgically treated PPFF, accounting for differences in types of periprosthetic fractures and treatment options among Dutch orthopedic surgeons. Material & Methods: An online survey was distributed among the members of the hip and trauma working groups of the Dutch Orthopedic Association. Results: The response rate was 13% (n=75). The main finding was that postoperative load bearing regimes in case of Vancouver A, B and C PPFF differed greatly among Dutch orthopedic surgeons and no decisive guideline or consensus in postoperative load bearing regime after surgically treated PPFF was used in the Netherlands. Conclusion: In absence of decisive guidelines or consensus, more research is needed to explore the efficacy of PWB after surgically treated PPFF.

References: 1. Meys, G. et al. (2019): A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities. J Rehabil Med. 51(4): p. 290-297. Doi: 10.2340/16501977-2532. 2. Tian, et al. (2017): Partial versus early full weight bearing after uncemented total hip arthroplasty: a meta-analysis. J Orthop Surg Res. 12(1): p. 31. Doi: 10.1186/s13018-017-0527-x. 3. Duncan, et al. (1995): Fractures of the femur after hip replacement. Instr Course Lect. 44: p. 293-304. PMID: 7797866.

Figure legends: 5 figures presenting the response of Dutch Orthopedic surgeons on postoperative load bearing regimen in PPFF Vancouver A, B1, B2, B3 and C.

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Ethical approval: this study is a survey-based study, no ethical approval was required.

Informed consent to participate: this study is a survey-based study, no informed consent was needed.

Informed consent to publish: this study is a survey-based study, no informed consent was needed.

Authors Contributions: All authors contributed to the study conception and design. Material preparation and data collection was performed by M.A.M. Vesseur. Analysis were performed by M.A.M. Vesseur, J. Jelsma and J. Most. The first draft of the manuscript was written by M.A.M. Vesseur and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Funding: the authors did not receive support from any organization for the submitted work.

Competing Interests: the authors have no relevant financial or non-financial interests to disclose.

Availability of data and materials: not applicable.

Acknowledgements: None.