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Management of Periprosthetic Femoral Fractures following Total Hip Replacement: A Case Series

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Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 100-103 | Lokesh Kumar Yogi, Vijay Chandrakant Shinde, Moti Janardhan Naik, Vikash Kumar

DOI:10.13107/jcorth.2022.v07i01.485

Author: Lokesh Kumar Yogi [1], Vijay Chandrakant Shinde [1], Moti Janardhan Naik [1], Vikash Kumar [2]

[1] Department of Orthopaedic Surgery, Government Medical College, Aurangabad, Maharashtra, India.

[2] Department of Orthopaedic Surgery, Deen Dayal Upadhyaya Hospital, New Delhi, India.

Address of Correspondence
Dr. Lokesh Kumar Yogi,
Department of Orthopaedic Surgery, Government Medical College, Aurangabad, Maharashtra, India.
E-mail: lokesh.k.yogi@gmail.com

Abstract

Background: Periprosthetic femoral fractures following total hip arthroplasty (THA) are not very uncommon. At present the Vancouver classification provides management algorithm for deciding treatment options but treatment options may vary between surgeons, where as in this study most patients managed were according to Vancouver classification management algorithm. The most common treatment modality for treating periprosthetic femoral fractures around a well-fixed stem is with osteosynthesis, but fracture with loose stem requires revision arthroplasty and fracture with poor bone requires bone graft augmentation.

Methods: We reviewed 21 consecutive cases with periprosthetic femoral fractures in association with THA between June 2018 and December 2020. Locking and non locking compression plates, wires, cables system were used for osteosynthesis. Most of fractures were managed according to Vancouver classification management algorithm but modified in some cases according to the surgeon’s skills and judgment.

Results: According to Vancouver classification, two patients had AL fractures, two patients had AG fractures, twelve Patients had B1, five patients had B2, two patients had B3 and one patient had type C fracture. Of these two cases were treated by conservatively, sixteen cases were treated by osteosynthesis, three cases by revision arthroplasty.

Conclusion: The careful analysis of implant stability and fracture patterns is crucial for the optimal treatment of Periprosthetic femoral fractures. Expert Surgeon’s skills are needed to deal with periprosthetic femoral fractures.

Keywords: Locking compression plate, periprosthetic fractures, total hip arthroplasty, Vancouver classification

References

  1. Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007;38(6):651-4.
  2. Berend ME, Smith A, Meding JB, Ritter MA, Lynch T, Davis K. Long-term outcome and risk factors of proximal femoral fracture in uncemented and cemented total hip arthroplasty in 2551 hips. J Arthroplasty. 2006;21(6 Suppl 2):53-9.
  3. Garbuz DS, Masri BA, Duncan CP. Periprosthetic fractures of the femur: principles of prevention and management. Instr Course Lect. 1998;47:237-42.
  4. Haddad FS, Masri BA, Garbuz DS, Duncan CP. The prevention of periprosthetic fractures in total hip and knee arthroplasty. Orthop Clin North Am. 1999;30:191-207.
  5. Katzer A, Ince A, Wodtke J. Component exchange in treatment of periprosthetic femoral fractures. J Arthroplasty. 2006; 21:572-9.
  6. Brady OH, Garbuz DS, Masri BA, Duncan CP. The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty2000;15:59–62.
  7. Naqvi GA, Baig SA, Awan N. Interobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty. J Arthroplasty 2012;27:1047-1050.
  8. Tsiridis E, Haddad FS, Gie GA. The management of periprosthetic femoral fractures around hip replacements. Injury. 2003;34:95-105.
  9. Grammatopoulos G, Pandit H, Kambouroglou G. A unique peri-prosthetic fracture pattern in well xed femoral stems with polished, tapered, collarless design of total hip replacement. Injury. 2011; 42:1271-6.
  10. Campbell P, Mcwilliams TG. Periprosthetic femoral fractures. Curr Orthop. 2002;16:126-32.
  11. Lewallen DG, Berry DJ. Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date. Instr Course Lect. 1998;47:243-9.
  12. Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish NationalHip Arthroplasty Register. J Arthroplasty. 2005;20:857-65.
  13. Corten K, Vanrykel F, Bellemans J, Frederix PR, Simon JP, Broos PL. 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(11):1424–1430.
  14. Marsland D, Mears SC. A review of periprosthetic femoral fractures associated with total hip arthroplasty. Geriatr Orthop Surg Rehabil 2012;3(3):107–120.
  15. Streubel PN. Mortality after periprosthetic femur fractures. J Knee Surg2013;26:27–30.
  16. Sledge JB, Abiri A (2002) An algorithm for the treatment of Vancouver type B2 periprosthetic proximal femoral fractures. J Arthroplasty 17:887–892.
  17. Beals RK, Tower SS (1996) Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop 327:238–246.
  18. Kavanagh BF. Femoral fractures associated with total hip arthroplasty. Orthop Clin North Am. 1992;23:249-57.
  19. McElfresh EC, Coventry MB. Femoral and pelvic fractures after total hip arthroplasty. J Bone Joint Surg Am. 1974;56:483-92.
  20. Porsch M, Galm R, Hovy L, Starker M, Kerschbaumer F (1996) Total femur replacement following multiple periprosthetic fractures between ipsilateral hip and knee replacement in chronic rheumatoid arthritis. Case report of 2 patients. Z Orthop Ihre Grenzgeb 134(1):16-20.

 

How to Cite this article: Yogi LK, Shinde VC, Naik MJ, Kumar V. Management of periprosthetic femoral fractures following total hip replacement: A case series. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):100-103.

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En bloc Extraction Technique in Total Hip Arthroplasty for Avascular Necrosis Treated with Non-vascular Fibular Autografts

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Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 32-34 | Vikram I Shah, Javahir A Pachore, Gautam M Shetty, Amish Kshatriya, Ashish Sheth, Kalpesh Shah

Author: Vikram I Shah [1], Javahir A Pachore [2], Gautam M Shetty [3,4], Amish Kshatriya [1], Ashish Sheth [1], Kalpesh Shah [1]

[1] Department of Orthopaedic Surgery, Shalby Hospitals, Ahmedabad, Gujarat, India

[2] Department of Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat, India.

[3] Knee and Orthopaedic Clinic, Mumbai, Maharashtra, India.

[4] Head of Research, AIMD Research, India.

Address of Correspondence
Dr. . Javahir A Pachore,
Department of Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat, India
E-mail: japachore@rediffmail.com

Abstract

Performing a total hip arthroplasty (THA) in the presence of a previous fibular graft can be technically challenging and may be associated with complications. We describe a novel method of “en bloc extraction” of the fibular graft during THA to facilitate complete removal of the graft and adequate femoral preparation. This en bloc extraction technique is safe and effective for complete removal of fibular graft during THA performed in patients with non-vascularized fibula grafting for avascular necrosis.

Keywords: Avascular necrosis, fibular graft, total hip arthroplasty, hip, conversion arthroplasty

References

1. Pachore JA, Vaidya SV, Thakkar CJ, Bhalodia HK, Wakankar HM. ISHKS joint registry: A preliminary report. Indian J Orthop 2013;47:505-9.
2. Zhao DW, Yu XB. Core decompression treatment of early-stage osteonecrosis of femoral head resulted from venous stasis or artery blood supply insufficiency. J Surg Res 2015;194:614-21.
3. Nally FJ, Zanotti G, Buttaro MA, Dilernia FD, Mansilla I, Comba FM. THA conversion rate comparing decompression alone, with autologous bone graft or stem cells in osteonecrosis. Hip Int 2018;28:189-93.
4. Wei BF, Ge XH. Treatment of osteonecrosis of the femoral head with core decompression and bone grafting. Hip Int 2011;21:206-10.
5. Meyers MH. The surgical treatment of osteonecrosis of the femoral head with an osteochondral allograft. Acta Orthop Belg 1999;65:66-7.
6. Ligh CA, Nelson JA, Fischer JP, Kovach SJ, Levin LS. The effectiveness of free vascularized fibular flaps in osteonecrosis of the femoral head and neck: A systematic review. J Reconstr Microsurg 2017;33:163-72.
7. Aldridge JM 3rd, Urbaniak JR. Vascularized fibular grafting for osteonecrosis of the femoral head with unusual indications. Clin Orthop Relat Res 2008;466:1117-24.
8. Dean GS, Kime RC, Fitch RD, Gunneson E, Urbaniak JR. Treatment of osteonecrosis in the hip of pediatric patients by free vascularized fibular graft. Clin Orthop Relat Res 2001;386:106-13.
9. Ding H, Gao YS, Chen SB, Jin DX, Zhang CQ. Free vascularized fibular grafting benefits severely collapsed femoral head in concomitant with osteoarthritis in very young adults: A prospective study. J Reconstr Microsurg 2013;29:387-92.
10. Gangji V, Toungouz M, Hauzeur JP. Stem cell therapy for osteonecrosis of the femoral head. Expert Opin Biol Ther 2005;5:437-42.
11. Baksi DP, Pal AK, Baksi DD. Long-term results of decompression and muscle-pedicle bone grafting for  steonecrosis of the femoral head. Int Orthop 2009;33:41-7.
12. Alves EM, Angrisani AT, Santiago MB. The use of extracorporeal shock waves in the treatment of osteonecrosis of the femoral head: A systematic review. Clin Rheumatol 2009;28:1247-51.
13. Aaron RK, Lennox D, Bunce GE, Ebert T. The conservative treatment of osteonecrosis of the femoral head. A comparison of core decompression and pulsing electromagnetic fields. Clin Orthop Relat Res 1989;249:209-18.
14. Camporesi EM, Vezzani G, Bosco G, Mangar D, Bernasek TL. Hyperbaric oxygen therapy in femoral head necrosis. J Arthroplasty 2010;25 Suppl 6:118-23.
15. Morita D, Hasegawa Y, Okura T, Osawa Y, Ishiguro N. Long-term outcomes of transtrochanteric rotational osteotomy for non-traumatic osteonecrosis of the femoral head. Bone Joint J 2017;99-B:175-83.
16. Berend KR, Gunneson E, Urbaniak JR, Vail TP. Hip Arthroplasty after failed free vascularized fibular grafting for osteonecrosis in young patients. J Arthroplasty 2003;18:411-9..
17. Eward WC, Rineer CA, Urbainak R, Richard MJ, Ruch DS. The vascularized fibular graft in precollapse osteonecrosis: Is long term hip preservation possible? Clin orthop Relat Res 2012;470:2819-26.
18. Walter TS, Brawne JA, Ortemdo LA, Wellmam SS, Urbaniak JR, Bolognest MP. Cost-effectiveness analysis of free vascularized fibular grafting for osteonecrosis of the femoral head. J Surg Orthop Adv 2011;20:158-67.
19. Ryan SP, Woostar B, Jiranek W, Wellman S, Bolognesi M, Seyler T. Outcomes of conversion total hip arthroplasty from free vascularized fibular grafting. J Arthroplasty 2019;34:88-2.
20. Davis ET, Mckee MD, Wadell JP, Hupel T, Schemitsch EH. Total Hip arthroplasty following failure of free vascularized fibular graft. J Bone Joint Surg Am 2006;88:110-5.

How to Cite this article: Shah VI, Pachore JA, Shetty GM, Kshatriya A, Sheth A, Shah K. En bloc Extraction Technique in Total Hip Arthroplasty for Avascular Necrosis Treated with Non-vascular Fibular Autografts. Journal of Clinical Orthopaedics Jul-Dec 2021;6(2):32-34.

 (Abstract    Full Text HTML)   (Download PDF)