J Korean Hip Soc.  2011 Mar;23(1):66-71. 10.5371/jkhs.2011.23.1.66.

Surgical Management of Repeated Low-Energy Periprosthetic Femur Fractures: A Case Report

• Yoon TR
• Park KS
• Thevarajan K
• Cho NY

• KMID: 2190778
• DOI: http://doi.org/10.5371/jkhs.2011.23.1.66

Abstract

Periprosthetic fracture of the femur is an uncommon complication after total hip arthroplasty (THA), but it appears to be increasing in incidence as a result of the aging population demographics and the increased number of THAs that are being performed. Much interest has been generated regarding low energy fractures in the elderly, but repeated periprosthetic fractures in the same femur are uncommon. The authors present here the case of a 71 year old patient who sustained repeated low energy ipsilateral periprosthetic femur fractures. The initial injury was caused by a road traffic accident, but the subsequent fractures were all caused by low energy falls. The patient sustained proximal and distal femur fractures with implants in situ. The probable causes of such fractures was a combination of systemic and local host factors, such as osteoporosis, cortical stress risers, local osteopenia secondary to bed rest, quiescent infection and altered fracture site vascularity due to the internal fixation devices and multiple re-operations.

Keyword

Femur; Periprosthetic fracture; Total hip arthroplasty; Implant; Fixation

MeSH Terms

Accidents, Traffic
Aged
Aging
Aldosterone
Arthroplasty
Bed Rest
Bone Diseases, Metabolic
Demography
Femur
Hip
Humans
Incidence
Internal Fixators
Osteoporosis
Periprosthetic Fractures
Tacrine
Aldosterone
Tacrine

Figure

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  Fig. 1 (A) Anteroposterior radiograph of both hips showing an unstable left femur intertrochanteric fracture. (B) Postoperative radiograph after internal fixation with compression hip screw. (C) Postoperative radiograph after conversion to cemented bipolar hemiarthroplasty. (D) Postoperative radiograph after Girdle stone operation showing residual bone cement in the femoral canal.

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  Fig. 2 (A) Immediate postoperative radiograph after debridement and PROSTALAC insertion performed at our institution. Residual cement in the left femoral canal can be seen. (B) Acetabular component dislocation evident on radiograph two months after PROSTALAC insertion. (C) Osteotomy was performed, with revision and PROSTALAC change, to remove residual cement. Postoperative radiograph showing no residual cement. (D) Radiograph showing Vancouver type C periprosthetic fracture, incurred after 1st minor trauma.

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  Fig. 3 (A) Anteroposterior and (B) lateral radiographs of left femur after 2nd minor trauma showing comminuted distal femur supracondylar fracture. Shaft fracture shows signs of good union.

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  Fig. 4 Fresh femoral shaft fracture resulting from 3rd minor trauma, evident on (A) anteroposterior and (B) lateral radiographs of left femur. Supracondylar fracture shows signs of healing with good callus formation.

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  Fig. 5 (A) Anteroposterior and (B) lateral radiographs of left femur after 2 years later from the last surgery showing complete union of femoral shaft and supracondylar fractures.

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