Management of Periprosthetic Femoral Fractures following Total Hip Replacement: A Case Series
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
- Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007;38(6):651-4.
- 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.
- Garbuz DS, Masri BA, Duncan CP. Periprosthetic fractures of the femur: principles of prevention and management. Instr Course Lect. 1998;47:237-42.
- 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.
- Katzer A, Ince A, Wodtke J. Component exchange in treatment of periprosthetic femoral fractures. J Arthroplasty. 2006; 21:572-9.
- 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.
- 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.
- Tsiridis E, Haddad FS, Gie GA. The management of periprosthetic femoral fractures around hip replacements. Injury. 2003;34:95-105.
- 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.
- Campbell P, Mcwilliams TG. Periprosthetic femoral fractures. Curr Orthop. 2002;16:126-32.
- 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.
- 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.
- 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.
- Marsland D, Mears SC. A review of periprosthetic femoral fractures associated with total hip arthroplasty. Geriatr Orthop Surg Rehabil 2012;3(3):107–120.
- Streubel PN. Mortality after periprosthetic femur fractures. J Knee Surg2013;26:27–30.
- Sledge JB, Abiri A (2002) An algorithm for the treatment of Vancouver type B2 periprosthetic proximal femoral fractures. J Arthroplasty 17:887–892.
- Beals RK, Tower SS (1996) Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop 327:238–246.
- Kavanagh BF. Femoral fractures associated with total hip arthroplasty. Orthop Clin North Am. 1992;23:249-57.
- McElfresh EC, Coventry MB. Femoral and pelvic fractures after total hip arthroplasty. J Bone Joint Surg Am. 1974;56:483-92.
- 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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