Periprosthetic fractures in the resurfaced hip—A case report and review of the literature

Abstract

Traumatic periprosthetic fractures adjacent a hip resurfacing prosthesis are rare. When proximal fractures are encountered the obvious surgical solution is to revise to a large head stemmed femoral component. A previously well functioning implant may however be retained as various non-operative and operative treatment options exist. This paper reports the case history of a traumatic periprosthetic fracture successfully treated with cannulated screw fixation and reviews the current literature.

Periprosthetic Intertrochanteric Fracture between Hip Resurfacing and Retrograde Nail

“…A recent series with 10-year follow-up documented only 2 cases of revision due to fracture [ 12 ]. However, early femoral neck fractures are generally attributed to the technical error of the primary surgery and patient factors [ 7 , 13 , 14 ]. Fracture risk increases with surgical errors such as excessive varus tilt of the implant, femoral neck notching, and poor seating of the implant [ 15 ].…”

“…Patient factors such as obesity, female sex, and osteoporosis increase the risk for femoral neck fractures [ 14 , 15 ]. Traumatic periprosthetic proximal femur fractures around hip resurfacing implants are uncommon and limited to case reports in the literature [ [2] , [3] , [4] , [5] , [6] , [7] , [8] ]. These case reports have detailed various patterns of traumatic injuries including the following: femoral neck, intertrochanteric, and subtrochanteric fractures [ 5 , 7 ].…”

“…Traumatic periprosthetic proximal femur fractures around hip resurfacing implants are uncommon and limited to case reports in the literature [ [2] , [3] , [4] , [5] , [6] , [7] , [8] ]. These case reports have detailed various patterns of traumatic injuries including the following: femoral neck, intertrochanteric, and subtrochanteric fractures [ 5 , 7 ]. Here, we present a case of an intertrochanteric fracture between a hip resurfacing and a retrograde femoral nail, which is, to the best of our knowledge, the only report of such injury.…”

“…Fractures around resurfacing implants can be challenging to stabilize as there is limited bone stock. Various methods of operative stabilization have been reported [2] , [3] , [4] , [5] , [6] , [7] , [8] . In the following section, we present an interesting case where these options were considered in a patient who underwent hip resurfacing and a previous retrograde intramedullary nailing.…”

Bilateral fixation of a periprosthetic intertrochanteric hip fracture below Birmingham hip resurfacing

“…Previous reports have shown successful treatment with retention of a well-functional implant 12. Conservation of bone stock with a view to possibly requiring later revision surgery was felt to be the best option given the patient's age.…”