Skip to main content
SpringerLink
Log in

Comparison of different fixation techniques for periprosthetic fractures: a biomechanical study of a new implant

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Introduction

The ideal treatment method for periprosthetic fractures is controversial due to the risks of current methods. Single-cortex screw fixation in prosthesis may lead to implant failure. Therefore, we aimed to develop an implant that lowers the risk for complications. For this study, we designed and tested two new implant models. The first model was a plate with a combination of U nails and cerclage holes. The second model was a U nail plate with a screw, which combines a plate screw with U nail (staples). Our study aimed to compare the stability of two newly designed implants with classical treatment modalities. We used 27 (in 3 groups) artificial bone models and 9 different test models.

Methods

The ISO 7206-4:2010 (E) standards were used for 27 bones in nine groups tested under laboratory conditions. In our study, we examined nine different groups. In group 1, hip the prosthesis was extracted, and a revision femoral stem was embedded. In group 2, periprosthetic fractures were repaired with a plate and cable. In group 3, periprosthetic fractures were repaired with a plate and stapler. In group 4, periprosthetic fractures were repaired with a plate and stapler cable. In group 5, periprosthetic fractures were repaired with a plate stapler and screw. Groups 6 and 7 were the control groups. Group 6 was the only artificial bone group, and group 7 was the prosthesis embedded bone group. Group 8 was periprosthetic fractures treated with unicortical screw fixation with cerclage, and group 9 was periprosthetic fractures treated with unicortical screw fixation. Axial loading was applied to the bones. The yield strength of the system was determined by loading the synthetic bone models with a constant compression speed of 5 mm/min through the centre of motion using the Geratech SH 2000 testing system. During the tests, load and displacement values were recorded, and the stiffness of the models was calculated based on those values.

Results

According to our results, the greatest durability was found in the revision hip prosthesis group (1511 N), and the weakest performance was found in the plate with the stapler implant group (163N). When comparing the data of groups according to compression, significant differences were found in group 2 with groups 1, 4, 5, and 7; group 3 with group 1; group 8 with groups 1 and 5; and group 9 with 1, 5, 7, and according to breakage, significant differences were found in group2 with groups 1, 3, 5, and 7; group 3 with group 1; group 8 with groups 1 and 5; and group 9 with groups 1, 5, and 7 (p<0.001).

Discussion

The revision hip prosthesis treatment for periprosthetic fractures showed the best performance, followed by the plate with stapler screw. In older patients, U nail-augmented implants may be a good alternative for periprosthetic fractures. Unicortical screw and cerclage wire combination fixation results were unsatisfactory results in this study.

Conclusion

This is an experimental study, so further studies, especially patient-specific studies, should be made to expand the findings of this study.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

Availability of data and material

Not applicable

Code availability

Not applicable

References

  1. Hoffmann MF, Burgers TA, Mason JJ, Williams BO, Sietsema DL, Jones CB (2014) Biomechanical evaluation of fracture fixation constructs using a variable-angle locked periprosthetic femur plate system. Injury 45:1035–1041. https://doi.org/10.1016/j.injury.2014.02.038

    Article  PubMed  Google Scholar 

  2. Fleischman AN, Chen AF (2015) Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls. Ann Transl Med 3:234. https://doi.org/10.3978/j.issn.2305-5839.2015.09

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mäkelä KT, Matilainen M, Pulkkinen P, Fenstad AM, Havelin LI, Engesaeter L, Furnes O, Overgaard S, Pedersen AB, Kärrholm J, Malchau H, Garellick G, Ranstam J, Eskelinen A (2014) Countrywise results of total hip replacement. An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database. Acta orthopaedica 85(2):107–116. https://doi.org/10.3109/17453674.2014.893498

  4. Legosz P, Platek AE, Rys-Czaporowska A, Szymanski FM, Maldyk P (2019) Correlations between Vancouver type of periprosthetic femur fracture and treatment outcomes. J Orthop 16:517–521. https://doi.org/10.1016/j.jor.2019.05.011

    Article  PubMed  PubMed Central  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  6. Davidson D, Pike J, Garbuz D, Duncan CPCP, Masri BABA (2008) Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am 90:2000–2012. https://doi.org/10.2106/JBJS.H.00331

    Article  PubMed  Google Scholar 

  7. Zdero R, Walker R, Waddell JPJP, Schemitsch EHEH (2008) Biomechanical evaluation of periprosthetic femoral fracture fixation. J Bone Joint Surg Am 90:1068–1077. https://doi.org/10.2106/JBJS.F.01561

    Article  PubMed  Google Scholar 

  8. Schmidt AH (2018) Problems in plating periprosthetic femur fractures. Injury 49:S49–S50

    Article  Google Scholar 

  9. Hoffmann MF, Jones CB, Sietsema DL, Koenig SJ, Tornetta P (2012) Outcome of periprosthetic distal femoral fractures following knee arthroplasty. Injury 43:1084–1089. https://doi.org/10.1016/j.injury.2012.01

    Article  CAS  PubMed  Google Scholar 

  10. Wang K, Kenanidis E, Miodownik M, Tsiridis E, Moazen M (2019) Periprosthetic fracture fixation of the femur following total hip arthroplasty: a review of biomechanical testing - Part II. Clin Biomech 61:144–162. https://doi.org/10.1016/j.clinbiomech.2018.12.001

    Article  Google Scholar 

  11. Siamos G, Winkler S, Boberick KG (2002) Relationship between implant preload and screw loosening on implant-supported prostheses. J Oral Implantol 28:67–73. https://doi.org/10.1563/1548-1336(2002)028<0067:TRBIPA>2.3.CO;2

    Article  PubMed  Google Scholar 

  12. Gaski GE, Scully SP (2011) In brief: classifications in brief: Vancouver vancouver classification of postoperative periprosthetic femur fractures. Clin Orthop Relat Res 469:1507–1510. https://doi.org/10.1007/s11999-010-1532-0

    Article  PubMed  Google Scholar 

  13. Iesaka K, Kummer FJ, Di Cesare PE (2005) Stress risers between two ipsilateral intramedullary stems: a finite-element and biomechanical analysis. J Arthroplast 20:386–391. https://doi.org/10.1016/j.arth.2004.05.002

    Article  Google Scholar 

  14. Lehmann W, Rupprecht M, Nuechtern J, Melzner D, Sellenschloh K, Kolb J, Fensky F, Hoffmann M, Püschel K, Morlock M, Rueger JM (2012) What is the risk of stress risers for interprosthetic fractures of the femur? A biomechanical analysis. Int Orthop 36:2441–2446. https://doi.org/10.1007/s00264-012-1697-0

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  16. 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 Arthroplast 15:523–528. https://doi.org/10.1054/arth.2000.4339

    Article  CAS  Google Scholar 

  17. Lever JP, Zdero R, Nousiainen MT, Waddell JP, Schemitsch EH (2010) The biomechanical analysis of three plating fixation systems for periprosthetic femoral fracture near the tip of a total hip arthroplasty. J Orthop Surg Res 5:45. https://doi.org/10.1186/1749-799X-5-45

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wu JC, Mills A, Grant KD, Wiater PJ (2019) Fracture fixation using shape-memory (Ninitol)staples. Orthop Clin North Am 50:367–374. https://doi.org/10.1016/j.ocl.2019.02.002

    Article  CAS  PubMed  Google Scholar 

  19. Yang PJ, Zhang YF, Ge MZ, Cai TD, Tao JC, Yang HP (1987) Internal fixation with Ni-Ti shape memory alloy compressive staples in orthopedic surgery. A review of 51 cases. Chin Med J 100:712–714

    CAS  PubMed  Google Scholar 

  20. Hoon QJ, Pelletier MH, Christou C, Johnson KA, Walsh WR (2016) Biomechanical evaluation of shape-memory alloy staples for internal fixation-an in vitro study. J Exp Orthop 3:19. https://doi.org/10.1186/s40634-016-0055-3

    Article  PubMed  PubMed Central  Google Scholar 

  21. Konya MN, Korkusuz F, Altin R, Maralcan G, Demir T (2021) Femur periprostetik kirik tedavisinde yeni tasarlanmiş u çivili plağin etkinliliği; karşilaştirmali biyomekanik çalişma. Kocatepe Tıp Dergisi 22:50–56. https://doi.org/10.18229/kocatepetip.699882

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thanks Enago for the English language review.

Funding

This study was supported by the Afyonkarahisar Health Science University.

Author information

Authors and Affiliations

  1. Orthopedics and Traumatology Department, Medical Faculty of Afyonkarahisar Health Science University, Afyonkarahisar, Turkey

    Mehmet Nuri Konya

  2. Department of Orthopedics and Traumatology, Gülhane Training and Research Hospital , Ankara, Turkey

    Ugur Yuzuguldu

  3. Department of Orthopedics and Traumatology, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey

    Recep Altin

  4. Department of Biomechanical Engineering, Afyon Kocatepe University, Afyonkarahisar, Turkey

    Ugur Fidan

Authors
  1. Mehmet Nuri Konya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ugur Yuzuguldu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Recep Altin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ugur Fidan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehmet Nuri Konya.

Ethics declarations

Ethics approval

This study approved by the Afyonkarahisar Health Science University Local Ethical Committee 06.12.2019/412.

Consent to participate

Not applicable

Consent to publication

Not applicable

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(JPEG 143 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Konya, M.N., Yuzuguldu, U., Altin, R. et al. Comparison of different fixation techniques for periprosthetic fractures: a biomechanical study of a new implant. International Orthopaedics (SICOT) 45, 1817–1826 (2021). https://doi.org/10.1007/s00264-021-05028-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-021-05028-y

Keywords

Search

Navigation