Aims. The objectives of this study were to investigate the patient characteristics and mortality of
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Periprosthetic fractures around a cemented femoral stem present a challenge to the treating surgeon. We propose a technique whereby a well fixed cement mantle can be retained in cases with simple fractures that can be reduced anatomically. This technique is well established in femoral stem revision, but not in association with a fracture. 24
Vancouver B fractures around a cemented polished tapered stem (CTPS) are often treated with revision arthroplasty. Results of osteosynthesis in these fractures are poor as per current literature. However, the available literature does not distinguish between fractures around CTPS from those around other stems. The aim of our study was to assess the clinical and radiological outcome of open reduction and internal fixation in Vancouver B fractures around CTPS using a broad non-locking plate. Patients treated with osteosynthesis between January 1997 and July 2011 were retrospectively reviewed. All underwent direct reduction and stabilisation using cerclage wires before definitive fixation with a broad DCP. Bicortical screw fixation was obtained in the proximal and distal fragments. We defined failure of treatment as revision for any cause. 101 patients (42 men and 59 women, mean age 79) were included. 70 had minimum follow-up of 6 months. 63 of these went on to clinical and radiological union. Three developed infected non-union. 7 had failure of fixation. Lack of anatomical reduction was the commonest predictor of failure followed by inadequate proximal fragment fixation and infection. 14 patients dropped at least 1 mobility grade from their preoperative status. This is the largest series of a very specific group of periprosthetic fractures treated with osteosynthesis. Patients who develop these fractures are often frail and “high risk” for major revision surgery. We recommend osteosynthesis for patients with Vancouver B periprosthetic fractures around CTPS provided these fractures can be anatomically reduced and adequately fixed.
Aims. Periprosthetic hip fractures (PPFs) after total hip arthroplasty are difficult to treat. Therefore, it is important to identify modifiable risk factors such as stem selection to reduce the occurrence of PPFs. This study aimed to clarify differences in fracture torque, surface strain, and fracture type analysis between three different types of cemented stems. Methods. We conducted biomechanical testing of bone analogues using six cemented stems of three different types: collarless polished tapered (CPT) stem, Versys Advocate (Versys) stem, and Charnley-Marcel-Kerboull (CMK) stem. Experienced surgeons implanted each of these types of stems into six bone analogues, and the analogues were compressed and internally rotated until failure. Torque to fracture and fracture type were recorded. We also measured surface strain distribution using triaxial rosettes. Results. There was a significant difference in fracture torque between the three stem types (p = 0.036). Particularly, the median fracture torque for the CPT stem was significantly lower than that for the CMK stem (CPT vs CMK: 164.5 Nm vs 200.5 Nm; p = 0.046). The strain values for the CPT stem were higher than those for the other two stems at the most proximal site. The fracture pattern of the CPT and Versys stems was
INTRODUCTION: The postoperative periprosthetic femoral fracture is a severe complication after total hip surgery. It has become the third most common reason for revision. Three-hundred and twenty one fractures operated during 1999–2000, were followed in a prospective nationwide study. The study focused on the failure rate, patient satisfaction, treatment and radiographic evaluation. PATIENTS AND METHODS: During 1999–2000, 230 fractures after a primary THR and 91 after a revision THR were reported to the Swedish National Hip Arthroplasty Register. All hospital records were collected. At follow-up the Harris hip score, a health-related quality of life measure (EQ-5D) and patient satisfaction were used as outcome measurement. A radiologist performed the radiographic evaluation. RESULTS: A high number of patients had a loose implant at fracture time (66% in the primary group and 51% in the revision group). Eighty-eight percent of the fractures were classified as
Introduction. The Vancouver Classification System presents a systematic approach to classification of periprosthetic fractures of the proximal femur (PFPFs) that has been validated in previous studies. However, with the introduction of tapered fluted stems and cable plates since the introduction of the Vancouver System, the connection between fracture class and the preferred method of treatment is often unclear. The present study was undertaken to identify fracture patterns surrounding contemporary femoral stems and the relationship between the current method of treatment and the Vancouver Class of the periprosthetic fracture. Methods. Three experienced joint surgeons collected plain radiographs (AP and lateral) and CT/MR scans (n=40) from 72 cases of Vancouver A or B periprosthetic fractures performed over the period 2016–2018. We identified the mode of primary stem fixation and the Vancouver grade of the fracture (A, B1, B2 or B3). Two independent investigators examined all imaging studies and the intraoperative records and recorded: (i) and the location and distribution of the fracture surfaces, and (ii) the presence of incomplete cortical fractures that had initiated within the femoral cortex without completing propagation and (iii) the method of operative treatment. These data were analyzed to examine the incidence of fractures within more than one femoral zone and differences in the fracture patterns corresponding to each Vancouver class. Results. One fifth (21%) of fractures were Type A with the remainder consisting predominantly of Type B2 (39%), with approximately equal proportions of Type B1 (22%) and B3 (18%) fractures. In almost half of Type B2 fractures (a loose femoral stem and a fracture adjacent to the prosthesis), fractures were also present within the metaphysis (ie. Type A+B). In the presence of a cementless femoral stem, fractures often occurred adjacent to the uncoated surface of the stem distal to the proximal ingrowth surface. Type B2 and B3 femurs had similar fracture patterns and degrees of comminution, though their method of treatment differed significantly. Incomplete fractures were identified in every Vancouver class (entire sample: 22%), especially in association with loose stems in poor quality bone (Type B3; 38% of cases). Conclusions. Approximately two-thirds of periprosthetic femoral fractures involve a loose femoral component (ie Types B2 and B3), though bone quality impacts operative treatment. In cementless stems,
With an increasing ageing population and a rise in the number of primary hip arthroplasty, peri-prosthetic fracture (PPF) reconstructive surgery is becoming more commonplace. The Swedish National Hip Registry reported that, in 2002, 5.1% of primary total hip replacements required revision due to PPF. Laboratory studies have indicated that age, bone quality and BMI all contribute to an increased risk of PPF. Osteolysis and aseptic loosening contribute to the formation of loosening zones as described by Gruen, with subsequent increased risk of fracture. The aim of the study was to identify significant risk factors for PPF in patients who have undergone primary total hip replacement (THR). Logbooks of three Consultant hip surgeons were filtered for patients who had THR-PPF fixation subsequent to trauma. Risk factors evaluated included sex, age, bone density (Singhs index), loosening zones, Vancouver classification, prosthesis stem angle relative to the axis of the femur, and length of time from THR to fracture. A control group of uncomplicated primary THR patients was also scrutinised. Forty-six PPF were identified representing 2.59% of THR workload. The male: female ratios in both groups were not significantly different (1:1.27 and 1:1.14 respectively). Average age of PPF was 72.1, which was significantly older than the control group (54.7, p>0.05). The commonest type of PPF was
We evaluated thirty six patients who underwent revision total hip arthroplasty for
