Hip Pelvis.  2015 Sep;27(3):146-151. 10.5371/hp.2015.27.3.146.

Outcomes of Surgical Treatment of Periprosthetic Femoral Fractures in Cementless Hip Arthroplasty

• Kim MW
• Chung YY
• Lee JH
• Park JH

• KMID: 2069144
• DOI: http://doi.org/10.5371/hp.2015.27.3.146

Abstract

PURPOSE
We aimed to evaluate the results of surgical treatment of periprosthetic femoral fractures in cementless total hip arthroplasty (THA).
MATERIALS AND METHODS
From June 2002 to May 2012, 40 patients who could be followed-up for more than 1 year after surgery were enrolled in this study. The mean duration of follow-up was 28.5 months (range, 15-97 months) and the average age at the time of surgery was 71.5 years (range, 38-89 years). The fracture types were determined by using the Vancouver classification. Among intraoperative fractures, there were type A in 3 hips, type B2 in 2 hips and type B3 in one. Among postoperative fractures, type AG was present in 5 hips, type AL in 2 hips, type B1 in 15 hips, type B2 in 6 hips, type B3 in 3 hips, and type C in 3 hips. Evaluation of the results was based on bony union, stability of the prosthesis, postoperative complications, and Harris hip score at the final follow-up.
RESULTS
Bony union was achieved in all but one case and the average time for bony union was 21 weeks. The mean Harris hip score was 86 at the final follow-up. Clinical results were above good in 34 of 40 hips (85.0%). Stem loosening occurred in one patient with a type B1 fracture treated with open reduction and plate fixation. Nonunion was observed in 1 patient with an AG type fracture.
CONCLUSION
Open reduction and fixation using a plate with a screw and cerclage wiring provided good results for periprosthetic fractures in patients who had a stable femoral stem without bone defects. Revision surgery with a cementless long stem should be considered in patients with an unstable stem or suspected stability in B1 type of THA using a proximal fixation type.

Keyword

Cementless hip arthroplasty; Periprosthetic femoral fracture; Surgical treatment

MeSH Terms

Arthroplasty*
Arthroplasty, Replacement, Hip
Classification
Femoral Fractures*
Follow-Up Studies
Hip*
Humans
Periprosthetic Fractures
Postoperative Complications
Prostheses and Implants

Figure

• 

  Fig. 1 (A) In a 73-year-old male patient, a Vancouver type B1 fracture occurred when he slipped down. (B) Stem revision was performed using a long distal-fitting-type stem, and internal fixation was performed with wiring. (C) At 19 months after operation, an X-ray showed bony union and no evidence of femoral stem loosening despite stem subsidence of about 5 mm.

• 

  Fig. 2 (A) In a 65-year-old male patient, a Vancouver type B1 fracture without stem loosening occurred after a fall. (B) The fracture was treated with a plate and screw. (C) At 27 months after operation, an X-ray showed progressive subsidence of the femoral stem. (D) Stem revision was performed using a long distal-fitting-type stem. (E) At 9 months after revision surgery, an X-ray showed bony union and stable stem fixation.

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