Management of periprosthetic femoral fractures following total hip arthroplasty: a review

Abdel, Matthew P.; Cottino, Umberto; Mabry, Tad M.

doi:10.1007/s00264-015-2979-0

Cited by 93 publications

(72 citation statements)

References 65 publications

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“…B-type fractures are in the region of the implant-bone interface and are further divided into three subtypes. B1 are stable and usually require ORIF [45]; in B2 fractures the implant is loose, and revision arthroplasty is required [46]; in B3 the implant is loose with inadequate bone remaining, and management can include proximal femoral replacement and bone grafting [47]. C-type fractures are below the implant, and can often be treated with ORIF if far enough away from the distal end of the implant to allow adequate plating [47].…”

Section: Fracture Classification and Managementmentioning

confidence: 99%

Periprosthetic femoral fractures following total hip and total knee arthroplasty

et al. 2018

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Total joint arthroplasties are increasing worldwide in both frequency and prevalence. When successful, they offer great improvements in quality of life. However, fractures around implants are often difficult to manage and require prolonged inpatient stays in tertiary hospitals. Management may differ between surgeons, but most patients will be managed surgically if mobility or joint stability is threatened. Those affected are often at higher risk from surgery, are frailer and at higher risk of mortality and a lifelong reduction in mobility. The incidence of these fractures is increasing, and patients should appreciate the risk and implications of this recognised complication of joint arthroplasty. Abbreviations: THA Total hip arthroplasty TKA Total knee arthroplasty PFF Periprosthetic femoral fracture BMI Body mass index ORIF Open reduction internal fixation

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Section: Fracture Classification and Managementmentioning

confidence: 99%

Periprosthetic femoral fractures following total hip and total knee arthroplasty

et al. 2018

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“…The incidence of periprosthetic femoral fractures (PFFs) is reported to be between 1% and 11% over a primary hip femoral stem and up to 18% over a revised hip femoral stem [1][2][3][4][5]. Their treatment is based on level of fracture, implant stability and quality of bone stock, and the comorbidity of the patient [2,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…The Vancouver classi cation developed by Duncan and Masri [10] is the most widely used for guiding the surgeon in pre-operative planning [7,[11][12][13], and it has been developed into the Uni ed Classi cation System for Periprosthetic Fractures [14,15]. New patterns of fracture has also been described for PFF around a hip femoral stem, with different prevalence over uncemented or cemented stem and apparently over stem geometry [16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

“…To date, most of the studies have produced therapeutic algorithms that focus on implant stability, leaving the choice of treatment to the habit of the surgeon, not de ning the best surgical strategy; both minimally invasive plate osteosynthesis (MIPO) obtaining an elastic xation or open reduction and internal xation (ORIF) with plate and cerclage with or without a structural allograft (or a second plate) have been advocated, based on mechanical issues [7,25,26,28,[40][41][42][43][44][45]. Anyway, the biological aspect of the patient has been neglected, considering it as not fundamental for the type of PFF and the surgical approach.…”

Section: Introductionmentioning

confidence: 99%

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Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

Mondanelli

Colasanti

Cataldi

et al. 2020

Preprint

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Background: There is lack of consensus regarding best operative fixation strategy for periprosthetic femoral fractures (PFFs) around a stable stem. Based on our experience in the treatment of nonunions after PFFs and other challenging cases and on Literature, we propose an algorithm that can guide in choosing the ideal surgical technique even for first-time PFFs with a stable stem.Methods: We retrospectively reviewed data on patients who failed to heal after a surgically treated Vancouver type B1 or C PFF. All patients were treated with locking plate, double structural allograft and autologous bone marrow concentrate (BMC) over a platelet-rich plasma (PRP)-based membrane at fracture site. All patients were also pharmacologically treated with Teriparatide in the postoperative period. We studied patients with radiograms, histological evaluation of the nonunion area, and phosphocalcic metabolism. Patients were assessed subjectively, clinically and radiographically until healing and then annually.Results: All nonunions healed over a six months period, and functional recovery appeared to be good. Retrospective evaluation of the proposed algorithm showed that none of the patients met biological or mechanical criteria such as to make valid the treatment with locking plate alone.Conclusion: Mechanical factors are not the only issues that should be taken into account when choosing the surgical approach to PFFs over a stable stem. Systemic and local biological conditions are factors that should drive to a rigid fixation with absolute stability (using a plate and structural allograft) plus local biological support (structural allograft and autologous BMC in a PRP-based scaffold) and systemic anabolic treatment (Teriparatide) in the first instance. A therapeutic algorithm is proposed, given the prosthetic stem to be stable, taking into account mechanical and biological criteria.

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“…FracturePeriprosthetic fractures (PPF) around a THA will continue to increase in prevalence as the number of primary THAs continues to increase. PPF are associated with increasing life longevity, poorer bone quality in the older patient, and higher demands in the younger patient 56. The Vancouver classification remains the gold standard for the diagnosis and treatment of postoperative periprosthetic femur fractures 57.…”

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confidence: 99%

Evaluation of the Painful Total Hip Arthroplasty

2018

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The total hip arthroplasty (THA) remains as one of the most successful procedures improving function and quality of life. However, despite its success, failures do occur. The workup of a painful THA should be methodical, prioritizing the most likely to least likely etiologies. Intrinsic and extrinsic sources of pain must be evaluated from data collected through an accurate history, detailed physical examination, laboratory analysis, and imaging interpretation.

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Management of periprosthetic femoral fractures following total hip arthroplasty: a review

Cited by 93 publications

References 65 publications

Periprosthetic femoral fractures following total hip and total knee arthroplasty

Periprosthetic femoral fractures following total hip and total knee arthroplasty

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

Evaluation of the Painful Total Hip Arthroplasty

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