Advertisement

Surgical treatment of periprosthetic femoral fractures: a retrospective study with functional and radiological outcomes from 2010 to 2016

  • Gaetano CarusoEmail author
  • Lorenzo Milani
  • Tedi Marko
  • Vincenzo Lorusso
  • Mattia Andreotti
  • Leo Massari
Original Article • HIP - ARTHROPLASTY

Abstract

Background

The treatment of periprosthetic femoral fractures is a great challenge for the orthopedic surgeon and requires a knowledge of bone fracture fixation as well as skills and experience in revision surgery. The aim of this retrospective study was to evaluate the functional and radiological outcomes of periprosthetic femoral fractures surgically treated in our department from 2010 to 2016.

Materials and methods

This study involved 73 patients with a periprosthetic femoral fracture after total hip arthroplasty or hemiarthroplasty. Periprosthetic femoral fractures were classified using the Vancouver system. Functional outcomes were assessed using Harris hip score, Palmer Parker score, SF-36 score and ambulatory status. Radiological findings were classified using Beals and Tower’s criteria.

Results

The mean age of patients was 79.6 years old. Local risks factors were identified in 67% of the patients, principally osteoporosis (63.0%), followed by osteolysis (26.0%) and loosening of the stem (8.2%). According to the Vancouver classification, there were 10 type A, 49 type B and 14 type C fractures. Of the type B fractures, 26 were B1, 17 were B2 and 6 were B3. Applying Beals and Tower’s criteria, radiological results were excellent in 24 patients (32.9%), good in 35 (47.9%) and poor in 14 (19.2%). The mean Harris hip score post-operatively was 72.5.

Conclusions

These kinds of fractures should be assessed individually and the optimal treatment plan should be made in accordance with the bone stock quality, stem stability, location of the fracture and patient expectations.

Keywords

Periprosthetic femoral fractures Outcome Harris hip score Surgical treatment 

Notes

Compliance with ethical standards

Ethical approval

The study was approved by the local University Hospital Human Subject Research Ethics Committee, and data collection and analysis were performed in compliance with the Declaration of Helsinki.

Conflict of interest

The authors have no conflicts of interest to declare.

References

  1. 1.
    Marsland D, Mears SC (2012) A review of periprosthetic femoral fractures associated with total hip arthroplasty. Geriatr Orthop Surg Rehabil 3:107–120CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Lewallen DG, Berry DJ (1998) Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date. Instr Course Lect 47:243–249PubMedGoogle Scholar
  3. 3.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785PubMedGoogle Scholar
  4. 4.
    Kärrholm J (2010) The swedish hip arthroplasty register. Acta Orthop 81(1):3–4CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304PubMedGoogle Scholar
  6. 6.
    Brand S, Ettinger M, Omar M, Hawi N, Krettek C, Petri M (2015) Concepts and potential future developments for treatment of periprosthetic proximal femoral fractures. Open Orhop J 9:405–411CrossRefGoogle Scholar
  7. 7.
    Parker MJ, Palmer CR (1993) A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 75:797–798CrossRefPubMedGoogle Scholar
  8. 8.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefPubMedGoogle Scholar
  9. 9.
    Beals RK, Tower SS (1996) Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res 327:238–246CrossRefGoogle Scholar
  10. 10.
    Bethea JS 3rd, DeAndrade JR, Fleming LL, Lindenbaum SD, Welch RB (1982) Proximal femoral fractures following total hip arthroplasty. Clin Orthop Relat Res 170:95–106Google Scholar
  11. 11.
    McElfresh EC, Coventry MB (1974) Femoral and pelvic fractures after total hip arthroplasty. J Bone Joint Surg Am 56:483–492CrossRefPubMedGoogle Scholar
  12. 12.
    Griffiths EJ, Cash DJ, Kalra S, Hopgood PJ (2013) Time to surgery and 30-day morbidity and mortality of periprosthetic hip fractures. Injury 44:1949–1952CrossRefPubMedGoogle Scholar
  13. 13.
    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 88:26–30CrossRefPubMedGoogle Scholar
  14. 14.
    Singh JA, Jensen MR, Harmsen SW, Lewallen DG (2013) Are gender, comorbidity, and obesity risk factors for postoperative periprosthetic fractures after primary total hip arthroplasty? J Arthroplasty 28(1):126–131CrossRefPubMedGoogle Scholar
  15. 15.
    Brady OH, Garbuz DS, Masri BA, Duncan CP (2000) The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty 15(1):59–62CrossRefPubMedGoogle Scholar
  16. 16.
    Holley K (2007) Periprosthetic fractures of the femur after hip arthroplasty: an analysis of 99 patients. HSS J 3(2):190–197CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Scholz R, Pretzsch M, Matzen P, von Salis-Soglio GF (2003) Treatment of periprosthetic femoral fractures associated with total hip arthroplasty. Z Orthop Ihre Grenzgeb 141(3):296–302CrossRefPubMedGoogle Scholar
  18. 18.
    Lindahl H, Garellick G, Regnér H, Herberts P, Malchau H (2006) Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am 88(6):1215–1222CrossRefPubMedGoogle Scholar
  19. 19.
    Montalti M, Pilla F, Guerra G, Traina F (2013) Periprosthetic femoral fractures: treatments and outcomes. An analysis of 47 cases. HIP Int 23(4):380–385CrossRefPubMedGoogle Scholar
  20. 20.
    Foster AP, Thompson NW, Wong J, Charlwood AP (2005) Periprosthetic femoral fractures: a comparison between cemented and uncemented hemiarthroplasties. Injury 36(3):424–429CrossRefPubMedGoogle Scholar
  21. 21.
    McGraw IWW, Spence SC, Baird EJ, Eckhardt SM, Ayana GE (2013) Incidence of periprosthetic fractures after hip hemiarthroplasty: are uncemented prostheses unsafe? Injury 44(12):1945–1948CrossRefPubMedGoogle Scholar
  22. 22.
    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(6):629–633CrossRefPubMedGoogle Scholar
  23. 23.
    Kim Y, Tanaka C, Tada H (2015) Treatment of periprosthetic femoral fractures after femoral revision using a long stem. BMC Musculoskelet Disord 16:113–119CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of Biomedical and Specialty Surgical SciencesAzienda Ospedaliero-Universitaria di Ferrara – Arcispedale Sant’Anna, University of FerraraFerraraItaly

Personalised recommendations