Outcomes of Surgical Treatment of Periprosthetic Femoral Fractures in Cementless Hip Arthroplasty

Abstract

Purpose: We aimed to evaluate the results of surgical treatment of periprosthetic femoral fractures in cementless total hip arthroplasty (THA).

Materials and methods: From June 2002 to May 2012, 40 patients who could be followed-up for more than 1 year after surgery were enrolled in this study. The mean duration of follow-up was 28.5 months (range, 15-97 months) and the average age at the time of surgery was 71.5 years (range, 38-89 years). The fracture types were determined by using the Vancouver classification. Among intraoperative fractures, there were type A in 3 hips, type B2 in 2 hips and type B3 in one. Among postoperative fractures, type AG was present in 5 hips, type AL in 2 hips, type B1 in 15 hips, type B2 in 6 hips, type B3 in 3 hips, and type C in 3 hips. Evaluation of the results was based on bony union, stability of the prosthesis, postoperative complications, and Harris hip score at the final follow-up.

Results: Bony union was achieved in all but one case and the average time for bony union was 21 weeks. The mean Harris hip score was 86 at the final follow-up. Clinical results were above good in 34 of 40 hips (85.0%). Stem loosening occurred in one patient with a type B1 fracture treated with open reduction and plate fixation. Nonunion was observed in 1 patient with an AG type fracture.

Conclusion: Open reduction and fixation using a plate with a screw and cerclage wiring provided good results for periprosthetic fractures in patients who had a stable femoral stem without bone defects. Revision surgery with a cementless long stem should be considered in patients with an unstable stem or suspected stability in B1 type of THA using a proximal fixation type.

Keywords: Cementless hip arthroplasty; Periprosthetic femoral fracture; Surgical treatment.

Fig. 1. (A) In a 73-year-old male patient, a Vancouver type B1 fracture occurred when he slipped down. (B) Stem revision was performed using a long distal-fitting-type stem, and internal fixation was performed with wiring. (C) At 19 months after operation, an X-ray showed bony union and no evidence of femoral stem loosening despite stem subsidence of about 5 mm.

Fig. 2. (A) In a 65-year-old male patient, a Vancouver type B1 fracture without stem loosening occurred after a fall. (B) The fracture was treated with a plate and screw. (C) At 27 months after operation, an X-ray showed progressive subsidence of the femoral stem. (D) Stem revision was performed using a long distal-fitting-type stem. (E) At 9 months after revision surgery, an X-ray showed bony union and stable stem fixation.