Periprosthetic femoral fractures following total hip and total knee arthroplasty

Abstract

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

Periprosthetic fractures after total knee arthroplasty: review

“…In 2017, Canton et al published their review, which included a larger database (52 studies) than ours, but the results were similar, concluding that arthroplasty, intramedullary nailing and locking plates are all appropriate methods of treatment that should be chosen depending on the patient and the fracture type [46]. The same conclusion was revealed by other reviewers before [47,48], and some authors have tried to guide physicians on how to choose between these methods, based on some criteria that can be found in the articles from our database as well. Kuzyk et al recommend choosing a fixation method, such as plates or nails, whenever the fracture occurs near a stable prosthesis, with enough bone quantity and quality to sustain fixation and competent collateral knee ligaments [49], otherwise revision should be considered.…”

Periprosthetic fractures of the knee: a comprehensive review

“…Femoral fractures around the metaphysis are usually managed with a single trans-condylar screw, and a diaphysis fracture can be fixated or stabilized with a stem that will pass the perforation by two or more cortices dimensions [23]. Tibial fractures occur more commonly during revision than primary total knee replacement [39]; however, they are less common than femoral fractures [38]. The treatment tactics for tibial intraoperative fractures are similar to those used regarding femoral.…”

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.

“…Anyway, we focused on a particular group of patients presenting re-fracture / nonunion of a PFF that were treated with repeated osteosynthesis and stem retention: revision arthroplasty for failed osteosyntheses can guarantee good results [54,55] and re-osteosynthesis can be applied to few cases, even if in continuous increase. Also, we based our proposal of a therapeutic algorithm to reduce failures in PFFs' treatment not only on the analyses of our series but also on the review of Literature [25,28,34,42,56]. Fractures with a stable stem (Vancouver B1 and C) are commonly treated by ORIF or by MIPO; ORIF can be enhanced with a structural allograft or with a second plate.…”

“…Type B1 fractures represent 30% and type C fractures represent 10% of all PFFs, and their treatment can be associated to a higher risk of complication than other PFFs types and high risk of failure due to nonunion with implant loosening and/or re-fracture [8,[25][26][27][28][29][30][31]. Clearly, this entails an important economic expense [32][33][34] and a high rate of morbidity and disability for these patients; moreover, mortality after PFFs and their treatment varies with patient age and concomitant disease between 4.5% and 22% [29,[35][36][37][38][39].…”