Diagnosis and management of periprosthetic femoral fractures after hip arthroplasty

Publication date: Available online 2 February 2019

Source: Injury

Author(s): Stefano Giaretta, Alberto Momoli, Giovanna Porcelli, Gian Mario Micheloni

ABSTRACT

Introduction

Periprosthetic femoral fracture represent a severe complication, at present the third cause of revision surgery, with an estimated incidence from 0,1 to 2,1%. The number of these fracture can be expect to increase in line with the aging of population and amount of THA implants also in younger high demanding patients.

Materials and Methods

The aim of this study is analyze the diagnostic and therapeutic decision making processes performed in 64 patients with periprosthetic fractures treated surgically from January 2012 and October 2016 in our center. We analysed instrumental exams and surgical reports focusing on type of procedure, surgical access, operative time and type of fixation.

Results

Average age was 80,9 years and a mean follow-up 23,1 months.

According to Vancouver system and after X-rays, CT scan and intraoperative evaluation, 26 fractures were classified as type B1, 31 as type B2, 3 type B3 and 4 type C.

Follow up results were divided on the basis of the surgical treatment: in ORIF group (23 type B1 fractures and 4 type C fracture) fracture union was obtained in 16 cases (59,3%) and the final HHS mean value was 61,61; in Revision group (3 type B1, 31 type B2 and 3 type B3) bone healing was reported in 26 cases (70,3%) with mean HHS score of 71,94.

Conclusions

In this surgery the objectives are provide an adequate bone healing and return to previous functional status as soon as possible. Many reasons make these goals challenging, in particular advanced age, osteoporosis, co-morbidity and weakness that lead to low energy trauma, the most frequent cause of these injuries. In our opinion a crucial aspect is the evaluation of stem stability, considering an implant mobilized until the opposite is clearly evident. Reduction of surgical time and early mobilization are goals of this surgery, often associated with several complications and high mortality rate.

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