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Outcome of periprosthetic femoral fractures following total hip replacement treated with polyaxial locking plate

  • Original Article • HIP - FRACTURES
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

The number of patients with total hip replacement (THR) is likely to grow. Periprosthetic femoral fractures occur in 0.1–4.5 % of patients with THR. Treatment of periprosthetic fractures in the vicinity of well-fixed implants has focused on lateral plating. The purpose of this study was to evaluate polyaxial locking plate treatment of periprosthetic fractures with THR in regard to fracture type, surgical procedure, complications, and outcome.

Methods

Between 2007 and 2013, 109 patients underwent surgical treatment for periprosthetic femur fractures with 66 fractures in the vicinity to a THR. Fifteen patients were excluded. Therefore, 51 patients with a mean age of 78.7 years were identified. There were 76.5 % females. Average BMI was 27.1 kg/m2. Follow-up averaged 25 months. Total hip stems were uncemented in 63 %. Low-energy mechanism predominated. Fractures were classified according to AO/OTA and Vancouver classifications with the majority (70.6 %) classified as AO/OTA type A fractures. Surgeries were performed utilizing a polyaxial locking plate. Complications were recorded concerning infection, union, fixation failure, and revision surgery.

Results

After the index procedure, 90.2 % healed. Non-union formation was diagnosed in 5.9 % with 2.0 % leading to hardware failure. All patients with non-union formation had interprosthetic fractures (χ 2 = 0.016). Additionally, these fractures were classified as AO/OTA type B fractures (χ 2 = 0.003).

Conclusions

Surgical management despite polyaxial locked plate fixation continues to be challenging and may still result in non-union formation. Non-union formation is increased in AO/OTA type B fractures and related to interprosthetic fractures.

Level of evidence

Level IV.

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Author’s contributions

MFH was involved in the data collection, performed the statistical analysis, participated in its design, carried out the literature search, performed the data interpretation, and drafted the manuscript. SL performed the data collection and was involved in revising the manuscript. TAS initiated the study, was involved in revising it critically for important intellectual content, and has given final approval of the version to be published. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany

    M. F. Hoffmann, S. Lotzien & T. A. Schildhauer

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  1. M. F. Hoffmann
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  2. S. Lotzien
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  3. T. A. Schildhauer
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Correspondence to M. F. Hoffmann.

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Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, and patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article.

Ethical standard

The study was approved by the Research Ethics Committee. Obtaining the informed consent from involved patients was waived by the Research Ethics Committee. All procedures involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments. Approval was granted from the Ruhruniversität—Bochum Institutional Review Board (Registration-No. 15-5406).

Additional information

This study has been presented at the 2015 Annual Meeting of the MidAmerican Orthopaedic Association (Hilton Head Island, SC) and the 2015 Annual OTA Meeting (San Diego, CA).

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Hoffmann, M.F., Lotzien, S. & Schildhauer, T.A. Outcome of periprosthetic femoral fractures following total hip replacement treated with polyaxial locking plate. Eur J Orthop Surg Traumatol 27, 107–112 (2017). https://doi.org/10.1007/s00590-016-1851-2

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  • DOI: https://doi.org/10.1007/s00590-016-1851-2

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