Management of late periprosthetic femur fractures: a retrospective cohort of 72 patients

Abstract

We present our series of 72 patients with periprosthetic fractures. The Vancouver classification was used to evaluate the fractures; there was one type A, seven type B1, 42 type B2, 17 type B3 and five type C fractures. Demographics, pre and postoperative data using Charnley-D'Aubigne-Postel score for assessment of function were recorded. The mean follow-up for all patients was two years. The overall outcome of treatment was graded as excellent, good or poor. An excellent result indicated that the arthroplasty was stable with minimal deformity and no shortening. Stable subsidence of the prosthesis or when the fracture healed with moderate deformity or shortening was deemed as a good result. A loose prosthesis, nonunion, sepsis, severe deformity or shortening was considered poor. In our series 79% (n=57) had good or excellent results following surgical intervention and 21% (n=15) had complications; they all had undergone re-operation for various reasons such as nonunion, loosening, dislocation or infection. In B2 fractures the stem is unstable and hence revision of the prosthetic stem has been recommended with or without additional fixation. For B3 fractures an allograft prosthesis composite or tumour prosthesis is considered the treatment choice.

What is the risk of stress risers for interprosthetic fractures of the femur? A biomechanical analysis

“…One major factor that cannot be simulated in such a biomechanical study is the loosening of the stem components. From various investigations, we know that this is a major stress riser for a periprosthetic fracture [10,11]. Some studies have shown that, even for interprosthetic fractures, the loosening between the cement and the stem plays an important role and occurs in most described cases [3].…”

Nickel-titanium shape-memory sawtooth-arm embracing fixator for periprosthetic femoral fractures

“…The treatment of periprosthetic femoral fractures presents a major clinical challenge in orthopaedic surgery [13]. Because of both the increase in average life span and the current popularity of hip-replacement, including revision procedures, this type of fracture is likely to be encountered more often in the future.…”

A New Technique in Revision Hip Arthroplasty for Vancouver B Periprosthetic Fractures

“…Previous studies on femoral stem revision for periprosthetic have reported dislocation rates between 3.6% and 20.8%. 12,[16][17][18] This is particularly problematic in patients who have had several previous operations, rendering the abductor mechanism incompetent.…”

“…This will generally occur within the first 6 postoperative months. 12,17,18,24,27 Subsidence may be minimized by restricting weight-bearing in the early postoperative period while osseointegration of the uncemented stem takes place. However, it was still evident in those series which adopted limited weight-bearing in the early postoperative period.…”

“…Dislocation rates between 3.6% and 20.8% have been reported. 12,[16][17][18] It has been shown that the trochanteric nonunion, small (22 mm) head size, a history of previous dislocation, and abductor deficiency are associated with an increased risk of dislocation after revision hip arthroplasty. The importance of minimizing soft-tissue dissection, retaining the capsule, and performing a sound capsular repair has been shown to significantly decrease the rate of dislocation in primary and revision hip arthroplasty cases.…”