Abstract:As the rate of hip and knee arthroplasty procedures increases, so will the rate of interprosthetic fractures. Several factors, including bone quality, bone quantity, and stability of the prosthetic components, play a role in determining the appropriate operative treatment. Patients with stable components should undergo reduction and internal fixation, while patients with loose components should undergo either revision arthroplasty, with or without additional fixation, or conversion to total femur replacement. … Show more
“…Our initial search provided 2156 articles and, after applying inclusion and exclusion criteria we identified a total of 49 studies. 8 - 10 , 33 , 35 - 79 Figure 1. Flow chart representing the search strategy for the articles included in the review according to PRISMA guidelines.…”
Section: Methodsmentioning
confidence: 99%
“…With regards to Su et al classification, considering a stable femoral component (Su type 1-2), the PFF is treated as a Vancouver type C as previously described. 36 , 75 , 76 In the case of a fracture on a primary TKA with an open box femoral component, a possible surgical option is represented by locked retrograde intramedullary nail. 36 , 54 , 75 A PFF over a stable TKA with a closed box or a stemmed femoral component will require, on the other hand, osteosynthesis with a plate.…”
Section: Methodsmentioning
confidence: 99%
“… 36 , 75 , 76 In the case of a fracture on a primary TKA with an open box femoral component, a possible surgical option is represented by locked retrograde intramedullary nail. 36 , 54 , 75 A PFF over a stable TKA with a closed box or a stemmed femoral component will require, on the other hand, osteosynthesis with a plate. 36 , 74 - 76 When loosening of the TKA femoral component is observed, due to fracture (Su type 3) or aseptic mobilization, the only possible treatment consists of total revision of the TKA.…”
Section: Methodsmentioning
confidence: 99%
“… 36 , 54 , 75 A PFF over a stable TKA with a closed box or a stemmed femoral component will require, on the other hand, osteosynthesis with a plate. 36 , 74 - 76 When loosening of the TKA femoral component is observed, due to fracture (Su type 3) or aseptic mobilization, the only possible treatment consists of total revision of the TKA. 36 , 75 , 76 Attention must be paid, in all cases, not to leave a segment of weakness between the tips of the hip and knee stem.…”
Section: Methodsmentioning
confidence: 99%
“… 36 , 74 - 76 When loosening of the TKA femoral component is observed, due to fracture (Su type 3) or aseptic mobilization, the only possible treatment consists of total revision of the TKA. 36 , 75 , 76 Attention must be paid, in all cases, not to leave a segment of weakness between the tips of the hip and knee stem. In order to avoid increased mechanical stresses and a new subsequent interprosthetic fracture, it is recommended to reinforce the construct with additional preventive plating and/or the use of structural graft overlapping the 2 implants.…”
Introduction. The ever-expanding indications for total hip arthroplasty are leading to more implants being placed in younger as well as in older patients with high functional demand. Also, prolonged life expectancy is contributing to an overall increment of periprosthetic femoral fractures. The Vancouver classification has been the most used for guiding the surgeon choice since its proposal in 1995. Fractures occurring over a hip femoral implant can be divided into intra-operative and post-operative PFFs, and their treatment depends on factors that may severely affect the outcome: level of fracture, implant stability, quality of bone stock, patients’ functional demand, age and comorbidities, and surgeon expertise. There are many different treatment techniques available which include osteosynthesis and revision surgery or a combination of both. The goals of surgical treatment are patients’ early mobilization, restoration of anatomical alignment and length with a stable prosthesis and maintenance of bone stock. Significance. The aim of this review is to describe the state-of-the-art treatment and outcomes in the management of PFFs. We performed a systematic literature review of studies reporting on the management of PFFs around hip stems and inter-prosthetic fractures identifying 45 manuscripts eligible for the analysis. Conclusions. PFFs present peculiar characteristic that must be considered and special features that must be addressed. Their management is complex due to the extreme variability of stem designs, the possibility of having cemented or uncemented stems, the difficulty in identifying the “real” level of the fracture and the actual stability of the stem. As a result, the definition of a standardized treatment is unlikely, thereby high expertise is fundamental for the surgical management of PPFs, so this kind of fractures should be treated only in specialized centres with both high volume of revision joint arthroplasty and trauma surgery.
“…Our initial search provided 2156 articles and, after applying inclusion and exclusion criteria we identified a total of 49 studies. 8 - 10 , 33 , 35 - 79 Figure 1. Flow chart representing the search strategy for the articles included in the review according to PRISMA guidelines.…”
Section: Methodsmentioning
confidence: 99%
“…With regards to Su et al classification, considering a stable femoral component (Su type 1-2), the PFF is treated as a Vancouver type C as previously described. 36 , 75 , 76 In the case of a fracture on a primary TKA with an open box femoral component, a possible surgical option is represented by locked retrograde intramedullary nail. 36 , 54 , 75 A PFF over a stable TKA with a closed box or a stemmed femoral component will require, on the other hand, osteosynthesis with a plate.…”
Section: Methodsmentioning
confidence: 99%
“… 36 , 75 , 76 In the case of a fracture on a primary TKA with an open box femoral component, a possible surgical option is represented by locked retrograde intramedullary nail. 36 , 54 , 75 A PFF over a stable TKA with a closed box or a stemmed femoral component will require, on the other hand, osteosynthesis with a plate. 36 , 74 - 76 When loosening of the TKA femoral component is observed, due to fracture (Su type 3) or aseptic mobilization, the only possible treatment consists of total revision of the TKA.…”
Section: Methodsmentioning
confidence: 99%
“… 36 , 54 , 75 A PFF over a stable TKA with a closed box or a stemmed femoral component will require, on the other hand, osteosynthesis with a plate. 36 , 74 - 76 When loosening of the TKA femoral component is observed, due to fracture (Su type 3) or aseptic mobilization, the only possible treatment consists of total revision of the TKA. 36 , 75 , 76 Attention must be paid, in all cases, not to leave a segment of weakness between the tips of the hip and knee stem.…”
Section: Methodsmentioning
confidence: 99%
“… 36 , 74 - 76 When loosening of the TKA femoral component is observed, due to fracture (Su type 3) or aseptic mobilization, the only possible treatment consists of total revision of the TKA. 36 , 75 , 76 Attention must be paid, in all cases, not to leave a segment of weakness between the tips of the hip and knee stem. In order to avoid increased mechanical stresses and a new subsequent interprosthetic fracture, it is recommended to reinforce the construct with additional preventive plating and/or the use of structural graft overlapping the 2 implants.…”
Introduction. The ever-expanding indications for total hip arthroplasty are leading to more implants being placed in younger as well as in older patients with high functional demand. Also, prolonged life expectancy is contributing to an overall increment of periprosthetic femoral fractures. The Vancouver classification has been the most used for guiding the surgeon choice since its proposal in 1995. Fractures occurring over a hip femoral implant can be divided into intra-operative and post-operative PFFs, and their treatment depends on factors that may severely affect the outcome: level of fracture, implant stability, quality of bone stock, patients’ functional demand, age and comorbidities, and surgeon expertise. There are many different treatment techniques available which include osteosynthesis and revision surgery or a combination of both. The goals of surgical treatment are patients’ early mobilization, restoration of anatomical alignment and length with a stable prosthesis and maintenance of bone stock. Significance. The aim of this review is to describe the state-of-the-art treatment and outcomes in the management of PFFs. We performed a systematic literature review of studies reporting on the management of PFFs around hip stems and inter-prosthetic fractures identifying 45 manuscripts eligible for the analysis. Conclusions. PFFs present peculiar characteristic that must be considered and special features that must be addressed. Their management is complex due to the extreme variability of stem designs, the possibility of having cemented or uncemented stems, the difficulty in identifying the “real” level of the fracture and the actual stability of the stem. As a result, the definition of a standardized treatment is unlikely, thereby high expertise is fundamental for the surgical management of PPFs, so this kind of fractures should be treated only in specialized centres with both high volume of revision joint arthroplasty and trauma surgery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
