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Treatment of periprosthetic femoral fractures after femoral revision using a long stem.

Kim Y, Tanaka C, Tada H, Kanoe H, Shirai T - BMC Musculoskelet Disord (2015)

Bottom Line: The average follow-up was 58.9 months (8 to 180).This failed case had a bone defect at the fracture site, and revision surgery using a cementless long stem and allografts was successful.These findings suggest that most cases of type B1 fracture after revision using a long stem have been treated successfully with open reduction and internal fixation.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kyoto City Hospital, 1-2 Mibu,higashitakada-cho, Nakagyo, Kyoto, 604-8845, Japan. woochan76@hotmail.co.jp.

ABSTRACT

Background: Periprosthetic femoral fractures are becoming increasingly common and are a major complication of total hip arthroplasty and hemiarthroplasty. The treatment of periprosthetic femoral fracture after femoral revision using a long stem is more complex and challenging. The purpose of this study was to identify the clinical and radiographical features of periprosthetic femoral fractures after revision using a long stem.

Methods: We report a retrospective review of the outcomes of treatment of 11 periprosthetic fractures after femoral revision using a long stem. Eleven female patients with a mean age of 79.2 years (70 to 91) were treated for a Vancouver type B1 fracture between 1998 and 2013. The mean numbers of previous surgeries were 3.1 (2 to 5).

Results: The average follow-up was 58.9 months (8 to 180). We found several important features that might influence the outcome of treatment for periprosthetic femoral fractures after femoral revision using a long stem: 1) all cases were classified as Vancouver type B1. 2) 6 patients (55%) had a transverse fracture around the tip of the long stem. 3) 7 patients (64%) had a history of previous fracture of the ipsilateral femur. The type B1 fractures were treated with open reduction and internal fixation in 9 hips, 6 of which were reinforced with bone grafts. Two other periprosthetic fractures were treated with femoral revision. One was revised because of stem breakage, and the other was a transverse fracture associated with poor bone quality, which received a femoral revision with a long stem and a plate. All fractures except one achieved primary union. This failed case had a bone defect at the fracture site, and revision surgery using a cementless long stem and allografts was successful.

Conclusions: These findings suggest that most cases of type B1 fracture after revision using a long stem have been treated successfully with open reduction and internal fixation. However, a transverse fracture with very poor bone quality might be considered as a type B3 fracture, and femoral revision might be a treatment of choice.

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Case 2, A seventy-three-years-old woman who sustained a Vancouver type-B1 periprosthetic femoral fracture one handred months after revision surgery using a long stem. A Anteroposterior radiograph of the left hip showing the Vancouver type-B1 frcture pattern. B Anteroposterior radiograph of the left hip made just after operation. C Anteroposterior radiograph of the left hip made one year after operation. Incorporation of the fracture site can be observed.
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Fig3: Case 2, A seventy-three-years-old woman who sustained a Vancouver type-B1 periprosthetic femoral fracture one handred months after revision surgery using a long stem. A Anteroposterior radiograph of the left hip showing the Vancouver type-B1 frcture pattern. B Anteroposterior radiograph of the left hip made just after operation. C Anteroposterior radiograph of the left hip made one year after operation. Incorporation of the fracture site can be observed.

Mentions: According to the Vancouver classification, type B1 fractures are recommended to be treated with open reduction and internal fixation (ORIF) without revision of the femoral component. In our patients, 9 periprosthetic femoral fractures were treated with ORIF using conventional or locking compression plate and cerclage wiring with or without bone grafts. Five of the 9 fractures were oblique fractures and were treated successfully with this method. Bone grafting was performed in 2 because they involved oblique fracture with comminution. Four of 9 fractures were transverse fractures. Bone grafting was associated with ORIF because a stable long stem increases the stress at the distal end, which can make bone union very difficult. In 3 patients, the bone united without problems as shown in Figure 3, but in 1 of these patients, bone union failed because of breakage of the plate (Figure 2). This failure was associated with a bone defect at the fracture site. The high stress concentration at the end of the stable long stem combined with this bone defect might have caused the failure despite the bone grafting. Revision surgery was performed with a cementless long stem in addition to allogeneic tibial bone plates with success.Figure 3


Treatment of periprosthetic femoral fractures after femoral revision using a long stem.

Kim Y, Tanaka C, Tada H, Kanoe H, Shirai T - BMC Musculoskelet Disord (2015)

Case 2, A seventy-three-years-old woman who sustained a Vancouver type-B1 periprosthetic femoral fracture one handred months after revision surgery using a long stem. A Anteroposterior radiograph of the left hip showing the Vancouver type-B1 frcture pattern. B Anteroposterior radiograph of the left hip made just after operation. C Anteroposterior radiograph of the left hip made one year after operation. Incorporation of the fracture site can be observed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4494722&req=5

Fig3: Case 2, A seventy-three-years-old woman who sustained a Vancouver type-B1 periprosthetic femoral fracture one handred months after revision surgery using a long stem. A Anteroposterior radiograph of the left hip showing the Vancouver type-B1 frcture pattern. B Anteroposterior radiograph of the left hip made just after operation. C Anteroposterior radiograph of the left hip made one year after operation. Incorporation of the fracture site can be observed.
Mentions: According to the Vancouver classification, type B1 fractures are recommended to be treated with open reduction and internal fixation (ORIF) without revision of the femoral component. In our patients, 9 periprosthetic femoral fractures were treated with ORIF using conventional or locking compression plate and cerclage wiring with or without bone grafts. Five of the 9 fractures were oblique fractures and were treated successfully with this method. Bone grafting was performed in 2 because they involved oblique fracture with comminution. Four of 9 fractures were transverse fractures. Bone grafting was associated with ORIF because a stable long stem increases the stress at the distal end, which can make bone union very difficult. In 3 patients, the bone united without problems as shown in Figure 3, but in 1 of these patients, bone union failed because of breakage of the plate (Figure 2). This failure was associated with a bone defect at the fracture site. The high stress concentration at the end of the stable long stem combined with this bone defect might have caused the failure despite the bone grafting. Revision surgery was performed with a cementless long stem in addition to allogeneic tibial bone plates with success.Figure 3

Bottom Line: The average follow-up was 58.9 months (8 to 180).This failed case had a bone defect at the fracture site, and revision surgery using a cementless long stem and allografts was successful.These findings suggest that most cases of type B1 fracture after revision using a long stem have been treated successfully with open reduction and internal fixation.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kyoto City Hospital, 1-2 Mibu,higashitakada-cho, Nakagyo, Kyoto, 604-8845, Japan. woochan76@hotmail.co.jp.

ABSTRACT

Background: Periprosthetic femoral fractures are becoming increasingly common and are a major complication of total hip arthroplasty and hemiarthroplasty. The treatment of periprosthetic femoral fracture after femoral revision using a long stem is more complex and challenging. The purpose of this study was to identify the clinical and radiographical features of periprosthetic femoral fractures after revision using a long stem.

Methods: We report a retrospective review of the outcomes of treatment of 11 periprosthetic fractures after femoral revision using a long stem. Eleven female patients with a mean age of 79.2 years (70 to 91) were treated for a Vancouver type B1 fracture between 1998 and 2013. The mean numbers of previous surgeries were 3.1 (2 to 5).

Results: The average follow-up was 58.9 months (8 to 180). We found several important features that might influence the outcome of treatment for periprosthetic femoral fractures after femoral revision using a long stem: 1) all cases were classified as Vancouver type B1. 2) 6 patients (55%) had a transverse fracture around the tip of the long stem. 3) 7 patients (64%) had a history of previous fracture of the ipsilateral femur. The type B1 fractures were treated with open reduction and internal fixation in 9 hips, 6 of which were reinforced with bone grafts. Two other periprosthetic fractures were treated with femoral revision. One was revised because of stem breakage, and the other was a transverse fracture associated with poor bone quality, which received a femoral revision with a long stem and a plate. All fractures except one achieved primary union. This failed case had a bone defect at the fracture site, and revision surgery using a cementless long stem and allografts was successful.

Conclusions: These findings suggest that most cases of type B1 fracture after revision using a long stem have been treated successfully with open reduction and internal fixation. However, a transverse fracture with very poor bone quality might be considered as a type B3 fracture, and femoral revision might be a treatment of choice.

Show MeSH
Related in: MedlinePlus