Abstract
Background: Periprosthetic fractures are now recognised as the second most frequent reason for revision following total hip replacement, less so than aseptic loosening but more so than dislocation and infection. The post-operative incidence of peri-prosthetic fracture is approximately 1% after primary arthroplasty and 4% after revision surgery. 75% of postoperative femoral fractures are associated with prosthetic loosening. The Vancouver system, a reliable and valid classification scheme, sub-classifies fractures around the stem of the prosthesis into three types. B2 is where there is a loose implant but adequate bone stock and B3 is where the implant is loose and bone stock is deficient.
Aim: To assess the outcome of patients with Vancouver type B2 and B3 fractures treated with femoral revision using an uncemented extensively porous coated implant (Solution ® stem).
Methods: A retrospective chart review was performed. Patients in addition attended for a clinical and radiographic assessment. Engh’s criteria for osseointegration of cementless components and the length of time to fracture union were the radiographic endpoints. The Harris hip score was used for clinical assessment with a score of above 80 indicating a satisfactory result.
Results: From July 1999 to present, we identified 22 such patients treated with this method. The mean duration of follow-up was 33.7 months with a minimum of 12 months. The mean age of patients was 78.7 years (range 67–88). The mean time from the index procedure to fracture was 10.8 years (range 7–20 years). The index procedure was a primary total hip replacement in all but 2 cases (revisions). 18 patients had a good result. Four patients had a poor result. The mean Harris Hip Score in the 18 patients was with good results was 82.7 and 69 in those with poor results. The mean duration to fracture union was 5.2 months (range 4–8 months). 17 patients needed concomitant acetabular cup revision. No patient showed any evidence of loosening or subsidence. 2 patients presented with deep seated infection (1 early, 1 late).
Conclusion: Periprosthetic fractures in the setting of a loose prosthesis present a difficult reconstructive challenge. Uncemented extensively porous coated femoral implants incorporate distal with intramedullary fixation of most fractures, permitting fracture healing as well as achieving osseointegration. We report good early survival rates, stable fixation and a low incidence of non union using this implant.
The abstracts were prepared by Emer Agnew. Correspondence should be addressed to Irish Orthopaedic Association, Secretariat, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
