Skip to main content

Advertisement

SpringerLink
Log in

Ipsilaterale Hüftendoprothese nach stielgeführter Knieendoprothese

Risiko einer interprothetischen Fraktur?

Ipsilateral THA after stemmed TKA

Risk of interprosthetic fracture?

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Anzahl an Patienten mit ipsilateraler stielgeführter Knietotalendoprothese (Knie-TEP) und Hüfttotalendoprothese (Hüft-TEP) steigt. Diese Patienten haben möglicherweise ein erhöhtes Risiko für eine interimplantäre Fraktur. Die Ätiologie und potenzielle Versorgungsstrategien dieser Frakturen sind in der Literatur nur gering abgebildet.

Ziel der Arbeit

Was sind Risikofaktoren für eine interimplantäre Fraktur und wie kann diese vermieden werden?

Material und Methoden

Es erfolgte eine Literaturrecherche, welche durch eine Expertenbefragung (Mitglieder der deutschen Gesellschaft für Endoprothetik – AE) zum Risiko und der Notwendigkeit einer Schutzosteosynthese ergänzt wurde.

Ergebnisse

Es existieren nur wenige biomechanische Studien zur Problematik. Die interprothetische Distanz hat danach wenig Einfluss auf die Frakturgefahr, vielmehr spielen die Dicke der Kortikalis bzw. die kortikale Fläche im Schaftbereich eine Rolle. Der Wert einer Schutzosteosynthese bleibt in der Literatur unklar.

An der Befragung nahmen 90 Mitglieder der AE teil. Die Gefahr einer interprothetischen Fraktur wurde insgesamt als gering bis mittel eingeschätzt, wobei die interprothetische Distanz und weitere Kriterien heterogen im Hinblick auf den Stellenwert als Entscheidungskriterium für eine Schutzosteosynthese eingeschätzt werden.

Diskussion

Die Indikation für eine Schutzosteosynthese konnte aus der Literatur nicht abgeleitet werden. Auch in der Expertenbefragung waren die Meinungen nicht einheitlich. Die kortikale Dicke und die Begleitererkrankungen des Patienten (Osteoporose, Fallneigung, Medikamente) scheinen geeigneter als die interprothetische Distanz, um die Indikation für eine Schutzosteosynthese abzuleiten.

Abstract

Background

There is an increasing number of patients who have undergone stemmed total knee arthroplasty and total hip arthroplasty in the same leg. These patients may be at increased risk of periprosthetic and interprostethic fracture. Etiology and the potential therapy strategies are not well represented in the current literature.

Objectives

Determination of the risk factors for interprosthetic fractures and possible prevention.

Materials and methods

We performed a review of the literature and additionally a survey among experts (members of the German Association for Arthroplasty [AE]) to investigate the risk and the necessity for a preventive internal fixation.

Results

There are only a few biomechanical studies. The interprosthetic distance seems to have little influence on the fracture risk, but the thickness of the cortex and the cortical area at the diaphysis seems to be important. The value of a bridging osteosynthesis remains uncertain.

Ninety experts took part in the survey. The risk of fracture risk was estimated to be only slight to medium. Opinions regarding the necessity of preventive internal fixation were heterogeneous.

Conclusions

The indication for preventive internal fixation could be derived neither from the literature nor from the survey of experts. The thickness of the cortex and co-morbidities (osteoporosis, tendency to fall, and medication) seem to be more important than the interprosthetic distance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Friesecke C, Plutat J, Block A (2005) Revision arthroplasty with use of a total femur prosthesis. J Bone Joint Surg Am 87:2693–2701

    Article  CAS  PubMed  Google Scholar 

  2. Fulkerson E, Tejwani N, Stuchin S, Egol K (2007) Management of periprosthetic femur fractures with a first generation locking plate. Injury 38(8):965–972

    Article  PubMed  Google Scholar 

  3. Kenny P, Rice J, Quinlan W (1998) Interprosthetic fracture of the femoral shaft. J Arthroplasty 13(3):361–364

    Article  CAS  PubMed  Google Scholar 

  4. Lehmann W, Rupprecht M, Hellmers N, Sellenschloh K, Briem D, Puschel K et al (2010) Biomechanical evaluation of peri- and interprosthetic fractures of the femur. J Trauma 68(6):1459–1463

    Article  PubMed  Google Scholar 

  5. Lehmann W, Rupprecht M, Nuechtern J, Melzner D, Sellenschloh K, Kolb J et al (2012) What is the risk of stress risers for interprosthetic fractures of the femur? A biomechanical analysis. Int Orthop 36(12):2441–2446

    Article  PubMed Central  PubMed  Google Scholar 

  6. Mamczak CN, Gardner MJ, Bolhofner B, Borrelli J Jr, Streubel PN, Ricci WM (2010) Interprosthetic femoral fractures. J Orthop Trauma 24(12):740–744

    Article  PubMed  Google Scholar 

  7. Osagie L, Figgie M, Bostrom M (2012) Custom total hip arthroplasty in skeletal dysplasia. Int Orthop 36(3):527–531

    Article  PubMed Central  PubMed  Google Scholar 

  8. Platzer P, Schuster R, Luxl M, Widhalm HK, Eipeldauer S, Krusche-Mandl I et al (2011) Management and outcome of interprosthetic femoral fractures. Injury 42(11):1219–1225

    Article  PubMed  Google Scholar 

  9. Rupprecht M, Schlickewei C, Fensky F, Morlock M, Puschel K, Rueger JM et al (2014) [Periprosthetic and interimplant femoral fractures: biomechanical analysis]. Unfallchirurg 5

  10. Soenen M, Baracchi M, De CR, Labey L, Innocenti B (2013) Stemmed TKA in a femur with a total hip arthroplasty: is there a safe distance between the stem tips? J Arthroplasty 28(8):1437–1445

    Article  PubMed  Google Scholar 

  11. Urch SE, Moskal JT (1998) Simultaneous ipsilateral revision total hip arthroplasty and revision total knee arthroplasty with entire femoral allograft. J Arthroplasty 13(7):833–836

    Article  CAS  PubMed  Google Scholar 

  12. Fink B, Fuerst M, Singer J (2005) Periprosthetic fractures of the femur associated with hip arthroplasty. Arch Orthop Trauma Surg 125(7):433–442

    Article  PubMed  Google Scholar 

  13. Hou Z, Moore B, Bowen TR, Irgit K, Matzko ME, Strohecker KA et al (2011) Treatment of interprosthetic fractures of the femur. J Trauma 71(6):1715–1719

    Article  PubMed  Google Scholar 

  14. Abendschein W (2003) Periprosthetic femur fractures–a growing epidemic. Am J Orthop (Belle Mead NJ) 32(9 Suppl):34–36

    Google Scholar 

  15. Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304

    CAS  PubMed  Google Scholar 

  16. Rorabeck CH, Taylor JW (1999) Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin North Am 30(2):209–214

    Article  CAS  PubMed  Google Scholar 

  17. Tricoire JL, Vogt F, Laffosse JM (2006) [Periprosthetic fractures around total hip and knee arthroplasty. Radiographic evaluation in periprosthetic fractures around the knee]. Rev Chir Orthop Reparatrice Appar Mot 92(5 Suppl):2S57–60

    Article  Google Scholar 

  18. Soenen M, Migaud H, Bonnomet F, Girard J, Mathevon H, Ehlinger M (2011) Interprosthetic femoral fractures: analysis of 14 cases. Proposal for an additional grade in the Vancouver and SoFCOT classifications. Orthop Traumatol Surg Res 97(7):693–698

    Article  CAS  PubMed  Google Scholar 

  19. Iesaka K, Kummer FJ, Di Cesare PE (2005) Stress risers between two ipsilateral intramedullary stems: a finite-element and biomechanical analysis. J Arthroplasty 20(3):386–391

    Article  PubMed  Google Scholar 

  20. Weiser L, Korecki MA, Sellenschloh K, Fensky F, Puschel K, Morlock MM et al (2014) The role of inter-prosthetic distance, cortical thickness and bone mineral density in the development of inter-prosthetic fractures of the femur: a biomechanical cadaver study. Bone Joint J 96-B(10):1378–1384

    Article  CAS  PubMed  Google Scholar 

  21. Franklin J, Malchau H (2007) Risk factors for periprosthetic femoral fracture. Injury 38(6):655–660

    Article  PubMed  Google Scholar 

  22. Lindahl H, Malchau H, Oden A, Garellick G (2006) Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br 88(1):26–30

    Article  CAS  PubMed  Google Scholar 

  23. Lavernia CJ (1998) Cost-effectiveness of early surgical intervention in silent osteolysis. J Arthroplasty 13(3):277–279

    Article  CAS  PubMed  Google Scholar 

  24. Erhardt JB, Kuster MS (2010) [Periprosthetic fractures of the knee joint]. Orthopade 39(1):97–108

    Article  CAS  PubMed  Google Scholar 

  25. Kobbe P, Klemm R, Reilmann H, Hockertz TJ (2008) Less invasive stabilisation system (LISS ) for the treatment of periprosthetic femoral fractures: a 3-year follow-up. Injury 39(4):472–479

    Article  PubMed  Google Scholar 

  26. Kolb W, Guhlmann H, Windisch C, Marx F, Koller H, Kolb K (2010) Fixation of periprosthetic femur fractures above total knee arthroplasty with the less invasive stabilization system: a midterm follow-up study. J Trauma 69(3):670–676

    Article  PubMed  Google Scholar 

  27. Dennis MG, Simon JA, Kummer FJ, Koval KJ, DiCesare PE (2000) Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques. J Arthroplasty 15(4):523–528

    Article  CAS  PubMed  Google Scholar 

  28. Kampshoff J, Stoffel KK, Yates PJ, Erhardt JB, Kuster MS (2010) The treatment of periprosthetic fractures with locking plates: effect of drill and screw type on cement mantles: a biomechanical analysis. Arch Orthop Trauma Surg 130(5):627–632

    Article  PubMed  Google Scholar 

  29. Peters CL, Bachus KN, Davitt JS (2003) Fixation of periprosthetic femur fractures: a biomechanical analysis comparing cortical strut allograft plates and conventional metal plates. Orthopedics 26(7):695–699

    PubMed  Google Scholar 

  30. Wilson D, Frei H, Masri BA, Oxland TR, Duncan CP (2005) A biomechanical study comparing cortical onlay allograft struts and plates in the treatment of periprosthetic femoral fractures. Clin Biomech (Bristol, Avon) 20(1):70–76

    Article  Google Scholar 

  31. Tsiridis E, Narvani AA, Timperley JA, Gie GA (2005) Dynamic compression plates for Vancouver type B periprosthetic femoral fractures: a 3-year follow-up of 18 cases. Acta Orthop 76(4):531–537

    Article  PubMed  Google Scholar 

  32. Faschingbauer M, Pingen O, Jürgens C, Wolter D (2005) Erfahrungen mit winkelstabilen Plattensystemen bei periprothetischen Frakturen. Trauma Berufskrankh 7:33–38

    Article  Google Scholar 

  33. El-Zayat BF, Ruchholtz S, Efe T, Fuchs-Winkelmann S, Kruger A, Kreslo D et al (2012) NCB-plating in the treatment of geriatric and periprosthetic femoral fractures. Orthop Traumatol Surg Res 98(7):765–772

    Article  CAS  PubMed  Google Scholar 

  34. Norrish AR, Jibri ZA, Hopgood P (2009) The LISS plate treatment of supracondylar fractures above a total knee replacement: a case-control study. Acta Orthop Belg 75(5):642–648

    PubMed  Google Scholar 

  35. Malinin T, Latta LL, Wagner JL, Brown MD (1984) Healing of fractures with freeze-dried cortical bone plates. Comparison with compression plating. Clin Orthop Relat Res 190:281–286

  36. Otte S, Fitzek J, Wedemeyer C, Loer F, von KM, Saxler G (2006) Reinforcement of deficient femur with inlay strut grafts in revision hip arthroplasty: a small series. Arch Orthop Trauma Surg 126(10):649–653

  37. Chandler H, Clark J, Murphy S, McCarthy J, Penenberg B, Danylchuk K et al (1994) Reconstruction of major segmental loss of the proximal femur in revision total hip arthroplasty. Clin Orthop Relat Res 298:67–74

  38. Pak JH, Paprosky WG, Jablonsky WS, Lawrence JM (1993) Femoral strut allografts in cementless revision total hip arthroplasty. Clin Orthop Relat Res 295:172–178

Download references

Author information

Authors and Affiliations

  1. UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    J. Dexel, A. Hartmann, J. Pyrc, K.-P. Günther & J. Lützner

Authors
  1. J. Dexel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Hartmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Pyrc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K.-P. Günther
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Lützner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Dexel.

Ethics declarations

Interessenkonflikt

J. Dexel, A. Hartmann, J. Pyrc, K.-P. Günther und J. Lützner geben an, dass keine Interessenkonflikte bestehen.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dexel, J., Hartmann, A., Pyrc, J. et al. Ipsilaterale Hüftendoprothese nach stielgeführter Knieendoprothese. Orthopäde 44, 489–496 (2015). https://doi.org/10.1007/s00132-015-3096-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-015-3096-x

Schlüsselwörter

Keywords

Search

Navigation