Hip Pelvis.  2015 Sep;27(3):187-191. 10.5371/hp.2015.27.3.187.

Periprosthetic Atypical Femoral Fracture-like Fracture after Hip Arthroplasty: A Report of Three Cases

• Lee KJ
• Min BW
• Jang HK
• Ye HU
• Lim KH

• KMID: 2069150
• DOI: http://doi.org/10.5371/hp.2015.27.3.187

Abstract

Atypical femoral fractures are stress or insufficient fractures induced by low energy trauma or no trauma and have specific X-ray findings. Although the American Society for Bone and Mineral Research has excluded periprosthetic fractures from the definition of an atypical femoral fracture in 2013, this is still a matter of controversy because some authors report periprosthetic fractures showing specific features of atypical fractures around a well-fixed femoral stem. We report 3 cases of periprosthetic femur fractures that had specific radiographic features of atypical femoral fractures in patients with a history of prolonged bisphosphonate use; we also review relevant literature.

Keyword

Hip; Periprosthetic fractures; Atypical femoral fracture

MeSH Terms

Arthroplasty*
Femoral Fractures
Femur
Hip*
Humans
Periprosthetic Fractures

Figure

• 

  Fig. 1 (A) Radiograph shows a periprosthetic femoral fracture with major radiographic features of an atypical femoral fracture. A transverse fracture line in the lateral cortex progresses medially across the femur. (B) Radiograph obtained 4 months before a complete fracture shows localized periosteal thickening of the lateral cortex and a transverse lucent fracture line (white arrow). (C) Radiograph obtained after osteosynthesis shows anterior plating. (D) Radiograph obtained 3 months after surgery shows metal failure at the site of the old fracture. (E) Re-fixation with dual plates and autogenous bone grafting. (F) Radiograph obtained 2.5 years after re-fixation shows good bone union at the fracture site.

• 

  Fig. 2 (A) Radiograph shows a periprosthetic femoral fracture with major radiographic features of an atypical femoral fracture. Note a transverse fracture line in the lateral cortex that progresses medially across the femur. (B) Radiograph obtained 3 months before a complete fracture. Note localized periosteal thickening of the anterolateral cortex and a transverse lucent fracture line (white arrow). (C) Radiograph obtained after osteosynthesis.

• 

  Fig. 3 (A) Anteroposterior pelvic radiograph shows a displaced atypical femoral fracture of the left femur characterized by localized periosteal thickening of the lateral cortex (white arrow). The radiograph also shows localized periosteal thickening of the lateral cortex of the right femur (black arrow). (B) Radiograph obtained just after closed reduction with internal fixation of the left atypical femoral fracture. Note localized periosteal thickening of the lateral cortex without a transverse lucent fracture line on the right femur (white arrow). (C) Radiograph obtained 6 months after surgery shows periosteal thickening of the lateral cortex with a transverse lucent fracture line on the right femur (white arrow). (D) Preventive osteosynthesis using a long plate was performed.

Reference

1. Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014; 29:1–23.

2. Niikura T, Lee SY, Sakai Y, Kuroda R, Kurosaka M. Rare non-traumatic periprosthetic femoral fracture with features of an atypical femoral fracture: a case report. J Med Case Rep. 2015; 9:103.

3. Curtin BM, Fehring TK. Bisphosphonate fractures as a cause of painful total hip arthroplasty. Orthopedics. 2011; 34:e939–e944.

4. Cross MB, Nam D, van der Meulen MC, Bostrom MP. A rare case of a bisphosphonate-induced peri-prosthetic femoral fracture. J Bone Joint Surg Br. 2012; 94:994–997.

5. Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect. 1995; 44:293–304.

6. Ha YC, Cho MR, Park KH, Kim SY, Koo KH. Is surgery necessary for femoral insufficiency fractures after long-term bisphosphonate therapy? Clin Orthop Relat Res. 2010; 468:3393–3398.

7. Prasarn ML, Ahn J, Helfet DL, Lane JM, Lorich DG. Bisphosphonate-associated femur fractures have high complication rates with operative fixation. Clin Orthop Relat Res. 2012; 470:2295–2301.

8. Hanssen AD. Revision total hip arthroplasty: the painful hip. J Bone Joint Surg Am. 2009; 91:Suppl 5. 22.