Proximal Femoral Fractures Following Total Hip Arthroplasty

BETHEA, J. STEPHEN; deAndrade, J. Robin; FLEMING, LAMAR L.; LINDENBAUM, STEPHEN D.; WELCH, RICHARD B.

doi:10.1097/00003086-198210000-00013

Cited by 190 publications

(102 citation statements)

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“…In one study, 75% of patients with periprosthetic fractures had prefracture radiographic evidence of loosening of the implant [5]. In a recent study, 70% of stems were considered loose when the patient sustained the periprosthetic fracture [19].…”

Section: Discussionmentioning

confidence: 99%

“…One of the most consistently mentioned predisposing factors is aseptic loosening of the femoral component. One study reported that 75% (22 of 35) of their patients had prefracture evidence of femoral component loosening [5]. Another study reported almost 50% of their patients had evidence of femoral component loosening as did other groups [11,13].…”

Section: Introductionmentioning

confidence: 99%

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Does Femoral Component Loosening Predispose to Femoral Fracture?: An In Vitro Comparison of Cemented Hips

Harris

Owen

Wayne

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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The incidence of femur fracture around total hip arthroplasties continues to increase at substantial cost to society. These fractures are frequently associated with a loose femoral component. Consequently, we sought to test whether femoral component loosening predisposes to periprosthetic femoral fracture. Because many periprosthetic femoral fractures are spiral in nature, we evaluated the torsional characteristics of the implanted femur in which the only design variable was instability of the femoral component. We used synthetic (polyurethane) (n = 15) and paired cadaveric femora (n = 10) with specimens divided into two groups: well-fixed and loose cemented stems. Each specimen was tested mechanically in internal rotation until failure. For the synthetic specimens, torque to failure was reduced by 38%, whereas stiffness was decreased 54% for the loose group compared with the well-fixed group. For the cadaveric specimens, torque to failure was reduced by 58%, whereas stiffness decreased 70% for the loose group compared with the wellfixed group. Fracture patterns were similar between synthetic and cadaveric femora with a proximal spiral pattern in loose specimens and more distal fracture patterns with well-fixed stems. Based on our data, patients with loosened femoral components are at risk for fracture at a substantially lower torque than those with well-fixed components.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does Femoral Component Loosening Predispose to Femoral Fracture?: An In Vitro Comparison of Cemented Hips

Harris

Owen

Wayne

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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show abstract

“…It is obviously more relevant to consider the presence of prosthetic loosening. Classification based on the relationship between the prosthetic tip and the medullary cavity (Johansson et al 1981) does not seem justified for clinical use; neither does the system used in other series (Bethea et al 1982).…”

Section: Discussionmentioning

confidence: 99%

“…Femoral fracture after arthroplasty is rare; only small materials have been reported ( Johansson et al 1981, Bethea et al 1982, and the outcome seems rather poor (Johansson et al 1981).…”

mentioning

confidence: 99%

Femoral shaft fracture after hip arthroplasty

Jensen¹,

Barfod²,

Hansen³

et al. 1988

Acta Orthopaedica Scandinavica

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“…Previous classification schemes and treatment algorithms for periprosthetic femur fractures focused primarily on location, fracture pattern, implant stability, and/or potential for loosening [2,7,13,18,21]. The Vancouver classification assimilates three key factors: location, stability of the implant, and the surrounding bone stock ( Table 1).…”

Section: Historymentioning

confidence: 99%