The authors declare that they have no competing interests.
YK wrote the manuscript, collected the data and examined the patients. ST, HT and HK contributed to examination of patients and data collection. CT performed study planning and reviewed the manuscript. All authors read and approved the final manuscript.
Periprosthetic femoral fractures are becoming increasingly common and are a major complication of total hip arthroplasty and hemiarthroplasty. The treatment of periprosthetic femoral fracture after femoral revision using a long stem is more complex and challenging. The purpose of this study was to identify the clinical and radiographical features of periprosthetic femoral fractures after revision using a long stem.
We report a retrospective review of the outcomes of treatment of 11 periprosthetic fractures after femoral revision using a long stem. Eleven female patients with a mean age of 79.2 years (70 to 91) were treated for a Vancouver type B1 fracture between 1998 and 2013. The mean numbers of previous surgeries were 3.1 (2 to 5).
The average follow-up was 58.9 months (8 to 180). We found several important features that might influence the outcome of treatment for periprosthetic femoral fractures after femoral revision using a long stem: 1) all cases were classified as Vancouver type B1. 2) 6 patients (55%) had a transverse fracture around the tip of the long stem. 3) 7 patients (64%) had a history of previous fracture of the ipsilateral femur. The type B1 fractures were treated with open reduction and internal fixation in 9 hips, 6 of which were reinforced with bone grafts. Two other periprosthetic fractures were treated with femoral revision. One was revised because of stem breakage, and the other was a transverse fracture associated with poor bone quality, which received a femoral revision with a long stem and a plate. All fractures except one achieved primary union. This failed case had a bone defect at the fracture site, and revision surgery using a cementless long stem and allografts was successful.
These findings suggest that most cases of type B1 fracture after revision using a long stem have been treated successfully with open reduction and internal fixation. However, a transverse fracture with very poor bone quality might be considered as a type B3 fracture, and femoral revision might be a treatment of choice.
Singh JA, Jensen MR, Lewallen DG. Patient factors predict periprosthetic fractures after revision total hip arthroplasty. J Arthroplasty. 2012;8:1507–12. CrossRef
Springer BD, Berry DJ, Lewallen DG. Treatment of periprosthetic femoral fractures following total hip arthroplasty with femoral component revision. J Bone Joint Surg Am. 2003;85-A:2156–62. PubMed
Meek RMD, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg (Br). 2011;93:96–101. CrossRef
Schwarzkopf R, Oni JK, Marwin SE. Total hip arthroplasty periprosthetic femoral fractures. Bull Hosp Jt Dis. 2013;71:68–78.
Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect. 1995;44:293–304. PubMed
Rayan F, Dodd M, Haddad FS. European validation of the Vancouver classification of periprosthetic proximal femoral fractures. J Bone Joint Surg (Br). 2008;90:1576–9. CrossRef
Tsiridis E, Narvani AA, Haddad FS, Timperley JA, Gie GA. Impaction femoral allografting and cemented revision for periprosthetic femoral fractures. J Bone Joint Surg (Br). 2004;86:1124–32. CrossRef
Gruen T. A simple assessment of bone quality prior to hip arthroplasty: Cortical index revisited. In: Acta Orthopaedica Belgica, vol. 63. 1997. p. 20–7.
Corten K, Vanrykel F, Bellemans J, Frederix PR, Simon J-P, Broos PLO. An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component. J Bone Joint Surg (Br). 2009;91:1424–30. CrossRef
Demos HA, Briones MS, White PH, Hogan KA, Barfield WR. A biomechanical comparison of periprosthetic femoral fracture fixation in normal and osteoporotic cadaveric bone. J Arthroplasty. 2012;5:783–8. CrossRef
Abhaykumar S, Elliott DS. Percutaneous plate fixation for periprosthetic femoral fractures--a preliminary report. Injury. 2000;31:27–30. CrossRef
Bobyn JD, Mortimer ES, Glassman AH, Engh CA, Miller JE, Brooks CE. Producing and avoiding stress shielding: laboratory and clinical observations of noncemented total hip arthroplasty. Clin Orthop Relat Res. 1992;274:79–96. PubMed
Engh CA, Bobyn JD. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop Relat Res. 1988;231:7–28. PubMed
- Treatment of periprosthetic femoral fractures after femoral revision using a long stem
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