J Korean Orthop Assoc.  2010 Apr;45(2):114-119. 10.4055/jkoa.2010.45.2.114.

Treatment of Periprosthetic Femoral Fractures after Hip Arthroplasty

• Lee JM
• Hwang DW
• Choi HJ
• Seol YD
• Lee DS

• KMID: 2185578
• DOI: http://doi.org/10.4055/jkoa.2010.45.2.114

Abstract

PURPOSE
To determine results of treatment according to the guidelines of the Vancouver classification in periprosthetic femoral fractures after total hip arthroplasty.
MATERIALS AND METHODS
Among 44 cases of periproshtetic femoral fractures after hip arthroplasty treated between Aug. 1991 and Feb. 2008, thirty-two cases with minimum follow-up greater than one year were included. Outcomes were evaluated using the Beals and Tower's critieria.
RESULTS
Outcomes were excellent in 27 cases, and poor in 5 cases. Four of 5 cases with poor result were due to non-union. Three cases were treated with internal fixation and 1 case was treated with a conservative method. One case with a poor result was due to loosening of the cemented stem of a Vancouver type B1 fracture. Loosening of the stem after mid to long term follow up occurred in an additional 4 cases (3 cases with a cemented stem in a type B1 fracture, 1 case with a cemented stem of a type C fracture). Loosened stems were revised with a long revision stem.
CONCLUSION
For type B1 periprosthetic fractures around a cementless stem, and for type B2, type B3 periprosthetic fractures, treatment according to the guidelines of the Vancouver classification showed excellent results. However, type B1 periprosthetic fractures around a cemented stem showed poor results with non-union or stem loosening. Hence, more rigid fixation using a bone graft or revision of the stem is needed. In type C periprosthetic fractures in osteoporotic patients, closer attentions is needed to avoid complications.

Keyword

periprosthetic femoral fracture; vancouver classification; total hip arthroplasty

MeSH Terms

Arthroplasty
Attention
Femoral Fractures
Follow-Up Studies
Hip
Humans
Periprosthetic Fractures
Transplants

Figure

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  Figure 1 (A), (B) Radiogragh of a 51-year-old male patient shows type B1 periprosthetic fracture around femoral stem treated with plate and bone graft. (C) Fracture with metal failure developed for 3 times, and was fixed with double plate and bone graft, finally. (D) Radiograph taken 2 years after the last operation shows stable stem fixation and union of fracture site.

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  Figure 2 (A), (B) Radiogragh of a 74-year-old female patient shows Type C periprosthetic femoral fracture augmented intramedullary with cement on distal femur, reduced and fixed with plate. (C), (D) After 1 year, another fracture with metal failure developed, and fixed with double plate with bone graft. (E) Radiograph taken 3 year 4 months after the last operation shows stable stem fixation and union of fracture site.

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