Surgical treatment of periprosthetic femoral fractures following hip arthroplasty: our institutional experience.

Periprosthetic fractures are one of the most serious complications after hip replacement. The aim of this retrospective study was to evaluate the clinical outcome of surgical treatment of periprosthetic femoral fractures following total hip arthroplasty using treatment algorithm of the Vancouver classification. Fifty six periprosthetic femoral fractures operated on during the period December 2004-September 2013 were followed-up retrospectively. There were 40 women and 16 men with mean age at the time of surgery 64.7 years (41-88 years). The mean follow-up for the group was 5 years (range, 1-10 years). Periprosthetic fractures were classified according to the Vancouver classification. The clinical evaluation was performed with the Harris hip score, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Short Form 8 (SF-8). Bone healing, implant survival, pain, function and complications were recorded. Bone healing and implant stability were evaluated clinically and on plain radiographs. Uneventful bone healing was achieved in 52 cases. In two fractures (one type B1, one type C) nonunion and plate failure occurred. Two cemented stems were revised for aseptic loosening 6.5 and 7 years after fracture fixation. Uncontrollable prosthesis infection and sepsis in a rheumatoid (immunocompromised) patient required disarticulation of the involved extremity. Periprosthetic femoral fractures are difficult to treat and require complex treatment approach according to risk assessment, fracture type, implant stability, bone stock and medical status of the patient. Using a treatment protocol of the Vancouver classification we obtained satisfactory outcome.

Kinov P ，Volpin G ，Sevi R ，Tanchev PP ，Antonov B ，Hakim G ... -  《-》

[Limited open reduction and double plates internal fixation for treatment of Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty].

Zhang Y ，Fan X ，Liu Y ，Shao J ，Tang J ，Liu S ，Yang T ，Zhang C ... -  《-》

[Periprosthetic Femoral Fractures after Total Hip Replacement: Our Results and Treatment Complications].

Pavelka T ，Salášek M ，Weisová D 《Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca》

[Plate osteosynthesis in vancouver type b1 and b2 periprosthetic fractures].

Fousek J ，Vasek P 《Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca》

High incidence of complications and poor clinical outcome in the operative treatment of periprosthetic femoral fractures: An analysis of 71 cases.

The purpose of this observational study was to determine the clinical results of the operative treatment of periprosthetic femoral fractures over a long period of time. The medical records of patients treated between 1993 and 2006 for a periprosthetic femoral fracture were obtained after a survey in two major hospitals. Radiographic evaluation was performed according to the Vancouver classification. All patients were contacted to fill out the Oxford hip score. A total of 80 PPFs were identified in 79 patients. For 71 patients with 71 fractures, medical records and radiographs were available. The mean age at the time of fracture was 73.4 years (range: 38-95 years). The mean interval between initial arthroplasty and the time of fracture was 6.3 years. As many as 44 fractures occurred in patients with primary hip arthroplasty (62%) and 27 fractures in patients with revision implants (38%). All but two patients were treated operatively and 34 patients (48%) suffered from a complication, leading to a re-operation in 22 cases (33%). The most frequent indication for re-operation was re-fracture or implant failure. Vancouver type-C fractures lead to re-operations in 52% of the cases (11 of 20). A total of 36 patients (51%) were able to complete an Oxford hip score after a mean period of 64.9 months (range: 16-157 months). The other patients were lost to follow-up (45% were deceased and 4% were mentally impaired). The mean Oxford hip score was 27.8 (range: 12-57) and was significantly higher in patients suffering from a complication (p=0.02) and in patients with a periprosthetic fracture (PPF) after revision surgery (p=0.02). The treatment of periprosthetic femoral fractures has a high complication rate and a large number of re-operations occur. The long-term clinical results are compromised by the event of a complication. The clinical results of treated fractures after a primary arthroplasty were better than after multiple arthroplasty procedures. Particularly, Vancouver type-C fractures showed high complication rates. This high complication rate should be taken into account for future studies in PPFs.

Zuurmond RG ，van Wijhe W ，van Raay JJ ，Bulstra SK ... -  《-》