Periprosthetic fractures of the femur after total hip arthroplasty: etiology and outcome

Abstract

Background. This article reports on our experience in the management of periprosthetic fractures of the femur. Materials and methods. We studied 44 patients (39 women and 5 men) with periprosthetic fractures of the femur after total hip replacement (THR). The average age of the patients at the time of surgery was 68 (range 33-82). Femoral fractures had occurred 1-20 years after THR in 27 hips. Revision hip arthroplasty was associated with periprosthetic fracture in 14 hips. Three patients had primary THR complicated by intraoperative femoral periprosthetic fracture. The outcome measures were bone union, delayed union or any revision intervention. Results. Bone union was achieved in 42 cases (95%). Thirty-five patients were satisfied with the surgical results, seven were moderately satisfied. Two patients had non-union of the femoral shaft, necessitating another intervention. The mean Harris Hip Score after bone union was 84 points (range 58-97). Deviation of the femoral axis was observed in 4 cases, due to subsiding of polished cemented stems. There were no deep infections. Conclusions. Internal stabilization with plate and cables is the best option in the treatment of fractured femur around a stable stem. Ineffective stabilization due to the use of a plate that was not long enough resulted in union with angulation. Long polished stems tended to subside within the cement mantle.