Abstract
We studied 14 periprosthetic femoral fractures out of a series of 619 hydroxyapatite coated hip implants and compared the outcome to published treatment algorithms using the Vancouver classification. There were five type A fractures, six B1, two B2, and one type B3 fracture. All but one type A fractures were treated conservatively. Compared with the Vancouver classification, we observed a different fracture type in the type B fractures. No fractures at the tip of the stem were seen, as in cemented implants. Three B1 fractures were treated operatively due to fracture displacement, and three were treated conservatively. The B2 and B3 fractures were managed with long, uncemented, revision stems because of a disrupted bone–prosthesis interface. All fractures healed well. This study confirms that the modified algorithm of management of periprosthetic fractures, using the Vancouver classification, is a simple, reproducible, classification system for uncemented prostheses. Conservative treatment is a valid option if the implant is stable whilst surgical intervention is mandatory if the implant is loose.
Résumé
Nous avons étudié 14 fractures fémorales péri prothétiques dans une série de 619 implants de la hanche recouverts d’hydroxyapatite et nous avons comparé le résultat à l’algorithme de traitement utilisant la classification de Vancouver. Il y avait cinq fractures de type A, six de type B1, deux de type B2 et une de type B3. Toutes les fractures de type A, sauf une, ont été traités d’une manière conservatrice. Comparé à la classification de Vancouver nous avons observé un type de fracture différent dans le type B. Aucune fracture à l’extrémité de la tige n’a été vue comme dans les implants cimentés. Trois fractures B1 ont été opérées à cause du déplacement et trois a été traité d’une manière conservatrice. Les fractures B2 et B3 ont été traités avec des tiges longues de révision, sans ciment, à cause d’une interface os-prothèse interrompu. Toutes les fractures ont consolidé. Cette étude confirme que l’algorithme modifié de gestion des fractures péri prothétiques, en utilisant la classification de Vancouver, est un système de classification simple, reproductible, pour les modalités du traitement avec des implants sans ciment. Le traitement conservateur est une option valable en cas d’implant stable, cependant qu’en cas d’implant descellé l’intervention chirurgicale est obligatoire.
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van der Wal, B.C.H., Vischjager, M., Grimm, B. et al. Periprosthetic fractures around cementless hydroxyapatite-coated femoral stems. International Orthopaedics (SICOT) 29, 235–240 (2005). https://doi.org/10.1007/s00264-005-0657-3
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DOI: https://doi.org/10.1007/s00264-005-0657-3