The complex problem of the interprosthetic femoral fracture in the elderly patient

Abstract

An ageing population and greater number of hip and knee replacements performed have led to an increasing number of patients with ipsilateral hip and knee replacements in situ. This often physiologically suboptimal population is at risk for periprosthetic fracture. An interprosthetic femoral fracture represents a unique challenge to the surgeon and requires a detailed multidisciplinary management strategy involving both fracture fixation and often complex revision. We have identified the largest series to our knowledge of patients presenting for surgical management of an unstable fracture between a hip and knee prosthesis. Institutional approval was granted for prospective study of these patients. We present the detailed management, outcome and review the known literature of the best practice for such a complex surgical case. We have outlined 9 fractures in 8 patients presenting to a single trauma unit. A variety of surgical options, often more than one, were employed. One patient died during the study period. All fractures progressed to union. There was a female preponderance with a mean age of 78 years. All patients had established systemic and metabolic bone morbidity. We believe this fracture pattern presents to the general orthopaedic surgeon a unique challenge, which bridges the expertise of the trauma and revision surgical spectrum. It is obvious that this will become an increasing issue with the median age of the population increasing. This case series highlights the need for ready availability of biological, arthroplasty and trauma systems to address such.