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Der Orthopäde

, Volume 48, Issue 4, pp 322–329 | Cite as

Periprothetische Frakturen des Acetabulums und des Femurs

Ursache – Klassifikation – Therapiealgorithmen
  • D. M. Ates
  • P. Koenen
  • R. Otchwemah
  • H. BäthisEmail author
Leitthema

Zusammenfassung

Hintergrund

Gesteigerte Implantationszahlen von Hüftendoprothesen einerseits und die Folgen des demographischen Wandels mit höheren Bevölkerungsanteilen älterer Menschen andererseits bedingen eine Zunahme periprothetischer Frakturen.

Ursachen

Stürze im häuslichen Umfeld stellen die häufigste Ursache dar. Als bedeutende Kofaktoren müssen eine reduzierte Koordination des Patienten, eine reduzierte Knochenqualität oder auch implantatassoziierte Faktoren, wie lokale Osteolysen oder eine vorbestehende Lockerung des Implantates angesehen werden.

Klassifikation

Bei der Einteilung der Fakturen am Femur hat sich innerhalb der letzten Jahre die Vancouver-Klassifikation durchgesetzt, welche neben einer Beschreibung der Lokalisation der Fraktur auch eine Beurteilung der Stabilität der Prothese und der Knochenqualität berücksichtigt. Darauf aufbauend wurden Therapiealgorithmen entwickelt, die vom konservativen Vorgehen über osteosynthetische Optionen bis hin zu einem Prothesenwechsel variieren können. Die Vancouver-Klassifikation, wurde als sog. UCS-Klassifikation weiterentwickelt, um, entsprechend der Systematik der AO-Klassifikation, die Beschreibung periprothetischer Frakturen an allen Gelenken zu ermöglichen. Bei der Auswahl des Therapieverfahrens ist die Berücksichtigung individueller Patientenfaktoren, wie Aktivitätsniveau und Nebendiagnosen, wesentlich. Anhand der etablierten Klassifikationen soll der Stellenwert der verschiedenen Therapieverfahren dargestellt werden.

Schlüsselwörter

Vancouver Klassifikation Osteolyse Osteosynthese Revisionschirurgie Hüfttotalendoprothese 

Abkürzungen

AAOS

American Academy of Orthopaedic Surgeons

AO

Arbeitsgemeinschaft für Osteosynthesefragen

CT

Computertomographie

OECD

Organisation for Economic Cooperation and Development

TEP

Totalendoprothese

UCS

Unified Classification System

Periprosthetic fractures of the acetabulum and femur

Causes—classification—treatment algorithms

Abstract

Background

Both increasing implantation numbers of total hip replacements and demographic change with higher populations of older people, indicate that there will be an increase in periprosthetic fractures in the future.

Causes

Falls in the home environment are the most common cause. Significant co-factors include reduced patient coordination, reduced bone quality, or implant-associated factors such as local osteolysis or pre-existing implant loosening.

Classification

In the classification of periprosthetic fractures of the femur, the Vancouver classification has prevailed in recent years, which in addition to a description of the localization of the fracture also considers the stability of the prosthesis and bone quality. Based on this, therapeutic algorithms have been developed that can vary from the conservative approach via osteosynthetic options to a replacement of the prosthesis. In order to allow the description of periprosthetic fractures on all joints, the Vancouver classification has been extended to the UCS classification by including the AO/OTA bone and joint coding system. In the selection of the treatment method, the consideration of individual patient factors such as activity level and secondary diagnoses is essential. Based on the established classifications, the importance of the different therapeutic methods is presented.

Keywords

Vancouver classification Osteolysis Osteosynthesis Revision surgery Total hip replacement 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

D. M. Ates, P. Koenen, R. Otchwemah und H. Bäthis geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Abdel MP, Watts CD, Houdek MT et al (2016) Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties. Bone Joint J 98–B:461–467.  https://doi.org/10.1302/0301-620X.98B4.37201 CrossRefGoogle Scholar
  2. 2.
    Agarwal S, Andrews CM, Bakeer GM (2005) Outcome following stabilization of type B1 periprosthetic femoral fractures. J Arthroplasty 20:118–121.  https://doi.org/10.1016/J.ARTH.2004.03.021 CrossRefGoogle Scholar
  3. 3.
    Beals RK, Tower SS (1996) Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res 327:238–246CrossRefGoogle Scholar
  4. 4.
    Benazzo F, Formagnana M, Bargagliotti M, Perticarini L (2015) Periprosthetic acetabular fractures. Int Orthop 39:1959–1963.  https://doi.org/10.1007/s00264-015-2971-8 CrossRefGoogle Scholar
  5. 5.
    Bethea JS, DeAndrade JR, Fleming LL et al (1982) Proximal femoral fractures following total hip arthroplasty. Clin Orthop Relat Res 170:95–106Google Scholar
  6. 6.
    Bleß H‑H, Kip M (2017) Weißbuch Gelenkersatz  https://doi.org/10.1007/978-3-662-53260-7 CrossRefGoogle Scholar
  7. 7.
    Brady OH, Garbuz DS, Masri BA, Duncan CP (2000) The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplast 15:59–62CrossRefGoogle Scholar
  8. 8.
    Brun O‑CL, Maansson L (2013) Fractures of the greater trochanter following total hip replacement. Hip Int 23:143–146.  https://doi.org/10.5301/HIP.2013.10813 CrossRefGoogle Scholar
  9. 9.
    Callaghan JJ (1997) Periprosthetic fractures of tthe acetabulum during and following total hip arthroplasty. J Bone Joint Surg Am 79(9):1416–1421CrossRefGoogle Scholar
  10. 10.
    Capone A (2017) Periprosthetic fractures: epidemiology and current treatment. Clin Cases Miner Bone Metab 14:189.  https://doi.org/10.11138/ccmbm/2017.14.1.189 CrossRefGoogle Scholar
  11. 11.
    Carli AV, Negus JJ, Haddad FS (2017) Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture? Bone Joint J 99-B(1 Supple A):50–59.  https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0220.R1 CrossRefGoogle Scholar
  12. 12.
    D’Antonio JA, Capello WN, Borden LS et al (1989) Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res 243:126–137Google Scholar
  13. 13.
    Dennis MG, Simon JA, Kummer FJ et al (2000) Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques. J Arthroplasty 15:523–528.  https://doi.org/10.1054/ARTH.2000.4339 CrossRefGoogle Scholar
  14. 14.
    Drew JM, Griffin WL, Odum SM et al (2016) Survivorship after periprosthetic femur fracture: factors affecting outcome. J Arthroplasty 31:1283–1288.  https://doi.org/10.1016/j.arth.2015.11.038 CrossRefGoogle Scholar
  15. 15.
    Duncan CP, Haddad FS (2014) The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J 96 B:713–716.  https://doi.org/10.1302/0301-620X.96B6.34040 CrossRefGoogle Scholar
  16. 16.
    Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304Google Scholar
  17. 17.
    Enocson A, Blomfeldt R (2014) Acetabular fractures in the elderly treated with a primary Burch-Schneider reinforcement ring, autologous bone graft, and a total hip arthroplasty: a prospective study with a 4-year follow-up. J Orthop Trauma 28:330–337.  https://doi.org/10.1097/BOT.0000000000000016 CrossRefGoogle Scholar
  18. 18.
    Fink B (2012) Periprothetische Frakturen bei Hüfttotalendoprothese. Trauma Berufskrankh 14:171–176.  https://doi.org/10.1007/s10039-012-1897-2 CrossRefGoogle Scholar
  19. 19.
    Haidukewych GJ, Jacofsky DJ, Hanssen AD, Lewallen DG (2006) Intraoperative fractures of the acetabulum during primary total hip arthroplasty. J Bone Joint Surg Am 88:1952–1956.  https://doi.org/10.2106/JBJS.E.00890 Google Scholar
  20. 20.
    Harris B, Owen JR, Wayne JS, Jiranek WA (2010) Does femoral component loosening predispose to femoral fracture?: an in vitro comparison of cemented hips. Clin Orthop Relat Res 468:497–503.  https://doi.org/10.1007/s11999-009-1034-0 CrossRefGoogle Scholar
  21. 21.
    Hasegawa K, Kabata T, Kajino Y et al (2017) Periprosthetic occult fractures of the acetabulum occur frequently during primary THA. Clin Orthop Relat Res 475:484–494.  https://doi.org/10.1007/s11999-016-5138-z CrossRefGoogle Scholar
  22. 22.
    Johansson JE, McBroom R, Barrington TW, Hunter GA (1981) Fracture of the ipsilateral femur in patients wih total hip replacement. J Bone Joint Surg Am 63:1435–1442CrossRefGoogle Scholar
  23. 23.
    Laflamme GY, Belzile EL, Fernandes JC, Vendittoli PA, Hébert-Davies J (2015) Periprosthetic fractures of the acetabulum during cup insertion: posterior column stability is crucial. J Arthroplasty 30:265–269.  https://doi.org/10.1016/j.arth.2014.09.013 CrossRefGoogle Scholar
  24. 24.
    Lindahl H, Garellick G, Regnér H et al (2006) Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg 88:1215–1222.  https://doi.org/10.2106/JBJS.E.00457 CrossRefGoogle Scholar
  25. 25.
    Lindahl H, Malchau H, Herberts P, Garellick G (2005) Periprosthetic femoral fractures: classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 20:857–865.  https://doi.org/10.1016/J.ARTH.2005.02.001 CrossRefGoogle Scholar
  26. 26.
    Lindahl H, Malchau H, Odén A, Garellick G (2006) Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br 88:26–30.  https://doi.org/10.1302/0301-620X.88B1.17029 CrossRefGoogle Scholar
  27. 27.
    Malkani AL, Paiso JM, Sim FH (2000) Proximal femoral replacement with megaprosthesis. Instr Course Lect 49:141–146Google Scholar
  28. 28.
    Masri BA, Meek RM, Duncan CP (2004) Periprosthetic fractures evaluation and treatment. : clinical orthopaedics and related research. Clin Orthop Relat Res 420:80–95CrossRefGoogle Scholar
  29. 29.
    McLean AL, Patton JT, Moran M (2012) Femoral replacement for salvage of periprosthetic fracture around a total hip replacement. Injury 43:1166–1169.  https://doi.org/10.1016/j.injury.2012.03.024 CrossRefGoogle Scholar
  30. 30.
    Mont MA, Maar DC (1994) Fractures of the ipsilateral femur after hip arthroplasty. A statistical analysis of outcome based on 487 patients. J Arthroplasty 9:511–519CrossRefGoogle Scholar
  31. 31.
    Moore RE, Baldwin K, Austin MS, Mehta S (2014) A systematic review of open reduction and internal fixation of Periprosthetic femur fractures with or without allograft strut, cerclage, and locked plates. J Arthroplasty 29:872–876.  https://doi.org/10.1016/J.ARTH.2012.12.010 CrossRefGoogle Scholar
  32. 32.
    Ninan TM, Costa ML, Krikler SJ (2007) Classification of femoral periprosthetic fractures. Injury 38:661–668.  https://doi.org/10.1016/J.INJURY.2007.02.053 CrossRefGoogle Scholar
  33. 33.
    Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty: a 6‑year follow-up evaluation. J Arthroplasty 9:33–44.  https://doi.org/10.1016/0883-5403(94)90135-X CrossRefGoogle Scholar
  34. 34.
    Parvizi J, Rapuri VR, Purtill JJ et al (2004) Treatment protocol for proximal femoral periprosthetic fractures. J Bone Joint Surg Am 86(A Suppl 2):8–16CrossRefGoogle Scholar
  35. 35.
    Peterson CA, Lewallen DG (1996) Periprosthetic fracture of the acetabulum after total hip arthroplasty. J Bone Joint Surg Am 78:1206–1213CrossRefGoogle Scholar
  36. 36.
    Pritchett JW (2001) Fracture of the greater trochanter after hip replacement. Clin Orthop Relat Res 390:221–226CrossRefGoogle Scholar
  37. 37.
    Rocca DGJ, Leung KS, Pape HC (2011) Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma.  https://doi.org/10.1097/BOT.0b013e31821b8c28 Google Scholar
  38. 38.
    Schuh A, Holzwarth U, Zeiler G (2004) Der modulare MRP-Titanrevisionsschaft in der Revisionsendoprothetik des Hüftgelenks. Orthopade 33:63–67.  https://doi.org/10.1007/s00132-003-0543-x CrossRefGoogle Scholar
  39. 39.
    Schwabe P, Märdian S, Perka C, Schaser KD (2016) Osteosynthese und Pfannenwechsel bei periprothetischer Azetabulumfraktur über einen Kocher-Langenbeck-Zugang. Oper Orthop Traumatol 28:91–103.  https://doi.org/10.1007/s00064-015-0425-5 CrossRefGoogle Scholar
  40. 40.
    Schwarzkopf R, Oni JK, Marwin SE (2013) Total hip arthroplasty periprosthetic femoral fractures: a review of classification and current treatment. Bull Hosp Jt Dis 71:68–78Google Scholar
  41. 41.
    Sidler-Maier CC, Waddell JP (2015) Incidence and predisposing factors of periprosthetic proximal femoral fractures: a literature review. Int Orthop 39:1673–1682.  https://doi.org/10.1007/s00264-015-2721-y CrossRefGoogle Scholar
  42. 42.
    Simon P, von Roth P, Perka C (2015) Treatment algorithm of acetabular periprosthetic fractures. Int Orthop 39:1995–2003.  https://doi.org/10.1007/s00264-015-2968-3 CrossRefGoogle Scholar
  43. 43.
    Stoffel K, Sommer C, Kalampoki V et al (2016) The influence of the operation technique and implant used in the treatment of periprosthetic hip and interprosthetic femur fractures: a systematic literature review of 1571 cases. Arch Orthop Trauma Surg 136:553–561.  https://doi.org/10.1007/s00402-016-2407-y CrossRefGoogle Scholar
  44. 44.
    Toogood PA, Vail TP (2015) Periprosthetic fractures: a common problem with a disproportionately high impact on healthcare resources. J Arthroplasty 30:1688–1691.  https://doi.org/10.1016/J.ARTH.2015.04.038 CrossRefGoogle Scholar
  45. 45.
    Valle DCJ, Momberger NG, Paprosky WG (2003) Periprosthetic fractures of the acetabulum associated with a total hip arthroplasty. Instr Course Lect 52:281–290Google Scholar
  46. 46.
    Wähnert D, Lenz M, Schlegel U et al (2011) Cerclage handling for improved fracture treatment. A biomechanical study on the twisting procedure. Acta Chir Orthop Traumatol Cech 78:208–214Google Scholar
  47. 47.
    Wähnert D, Schliemann B, Raschke MJ, Kösters C (2014) Versorgung periprothetischer Frakturen. Orthopade 43:306–313.  https://doi.org/10.1007/s00132-013-2165-2 CrossRefGoogle Scholar
  48. 48.
    Weißer M, Zerwes U, Krupka S et al (2017) Versorgungssituation. In: Weißb. Gelenk. Springer, Heidelberg, Berlin, Heidelberg, S 43–93CrossRefGoogle Scholar
  49. 49.
    Whittaker RP, Sotos LN, Ralston EL (1974) Fractures of the femur about femoral endoprostheses. J Trauma 14:675–694CrossRefGoogle Scholar
  50. 50.
    Zheng L, Lee W‑Y, Hwang D‑S et al (2016) Could patient Undergwent surgical treatment for periprosthetic femoral fracture after hip arthroplasty return to their status before trauma? Hip Pelvis 28:90.  https://doi.org/10.5371/hp.2016.28.2.90 CrossRefGoogle Scholar
  51. 51.
    Zhu Y, Chen W, Sun T et al (2015) Risk factors for the periprosthetic fracture after total hip arthroplasty: a systematic review and meta-analysis. Scand J Surg 104:139–145.  https://doi.org/10.1177/1457496914543979 CrossRefGoogle Scholar
  52. 52.
    Zuurmond RG, van Wijhe W, van Raay JJAM, Bulstra SK (2010) High incidence of complications and poor clinical outcome in the operative treatment of periprosthetic femoral fractures: an analysis of 71 cases. Injury 41:629–633.  https://doi.org/10.1016/j.injury.2010.01.102 CrossRefGoogle Scholar
  53. 53.
    (2018) Unified Classification System for Periprosthetic Fractures. J Orthop Trauma 32::S141–S144.  https://doi.org/10.1097/BOT.0000000000001068

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • D. M. Ates
    • 1
  • P. Koenen
    • 1
  • R. Otchwemah
    • 1
  • H. Bäthis
    • 1
    Email author
  1. 1.Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken Stadt Köln gGmbH, Klinikum Köln-Merheim, LehrstuhlUniversität Witten-HerdeckeKölnDeutschland

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