European Orthopaedics and Traumatology

, Volume 4, Issue 2, pp 103–109

Interprosthetic fractures—a challenge of treatment

  • Björn Gunnar Ochs
  • Ulrich Stöckle
  • Florian Gebhard
Review Article

Abstract

The incidence of periprosthetic femoral fractures rises continuously as both the number of hip and knee replacements and the life expectancy of the population are increasing. Likewise, interprosthetic femoral fractures, occurring between ipsilateral total hip and total knee arthroplasties, are an increasingly common and challenging problem. The majority of these fractures is localized at the femoral supracondylar region. Their treatment is not only technically demanding but also susceptible to complications. It has to be decided depending on the fracture type, surrounding bone stock, fracture localization, stability of the prosthesis, and the general condition of the often multimorbid patients whether osteosynthesis, revision of the prosthesis, or—when combined with periprosthetic infection—an amputation is indicated in the individual case. The modified Vancouver classification for interprosthetic femoral fractures was used for a systematic presentation of the indications, surgical techniques, and results.

Keywords

Periprosthetic femoral fractures Vancouver classification Hip and knee replacements 

References

  1. 1.
    Berry D (1999) Epidemiology: hip and knee. Orthop Clin North Am 30:183–190PubMedCrossRefGoogle Scholar
  2. 2.
    Chakravarthy J, Bansal R, Cooper J (2007) Locking plate osteosynthesis for Vancouver type B1 and type C periprosthetic fractures of femur: a report on 12 patients. Injury 38:725–733PubMedCrossRefGoogle Scholar
  3. 3.
    Chandler H, Tigges R (1998) The role of allografts in the treatment of periprosthetic femoral fractures. Instr Course Lect 47:257–264PubMedGoogle Scholar
  4. 4.
    Dennis M, Simon J, Kummer F et al (2001) Fixation of periprosthetic femoral shaft fractures: a biomechanical comparison of two techniques. J Orthop Trauma 15:177–180PubMedCrossRefGoogle Scholar
  5. 5.
    Dennis M, Simon J, Kummer F et al (2000) Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques. J Arthroplasty 15:523–528PubMedCrossRefGoogle Scholar
  6. 6.
    Duncan C, Masri B (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304PubMedGoogle Scholar
  7. 7.
    Erhardt J, Grob K, Roderer G et al (2008) Treatment of periprosthetic femur fractures with the non-contact bridging plate: a new angular stable implant. Arch Orthop Trauma Surg 128:409–416PubMedCrossRefGoogle Scholar
  8. 8.
    Fink B, Fuerst M, Singer J (2005) Periprosthetic fractures of the femur associated with hip arthroplasty. Arch Orthop Trauma Surg 125:433–442PubMedCrossRefGoogle Scholar
  9. 9.
    Franklin J, Malchau H (2007) Risk factors for periprosthetic femoral fracture. Injury 38:655–660PubMedCrossRefGoogle Scholar
  10. 10.
    Fulkerson E, Koval K, Preston C et al (2006) Fixation of periprosthetic femoral shaft fractures associated with cemented femoral stems: a biomechanical comparison of locked plating and conventional cable plates. J Orthop Trauma 20:89–93PubMedCrossRefGoogle Scholar
  11. 11.
    Gruner A, Hockertz T, Reilmann H (2004) Periprosthetic fractures: classification, management, therapy. Unfallchirurg 107:35–49PubMedCrossRefGoogle Scholar
  12. 12.
    Haddad F, Duncan C, Berry D et al (2002) Periprosthetic femoral fractures around well-fixed implants: use of cortical onlay allografts with or without a plate. J Bone Joint Surg Am 84-A:945–950PubMedGoogle Scholar
  13. 13.
    Head W, Wagner R, Emerson R Jr et al (1993) Restoration of femoral bone stock in revision total hip arthroplasty. Orthop Clin North Am 24:697–703PubMedGoogle Scholar
  14. 14.
    Hockertz T, Gruner A, Reilmann H (1999) Treatment of femoral fracture after total knee arthroplasty with the LIS system: a new method. Unfallchirurg 102:811–814PubMedCrossRefGoogle Scholar
  15. 15.
    Holzapfel B, Prodinger P, Hoberg M et al (2010) Periprosthetic fractures after total hip arthroplasty : classification, diagnosis and therapy strategies. Orthopade 39:519–535PubMedCrossRefGoogle Scholar
  16. 16.
    Hou Z, Moore B, Bowen T et al (2011) Treatment of interprosthetic fractures of the femur. J Trauma 71:1715–1719PubMedCrossRefGoogle Scholar
  17. 17.
    Iesaka K, Kummer F, Di Cesare P (2005) Stress risers between two ipsilateral intramedullary stems: a finite-element and biomechanical analysis. J Arthroplasty 20:386–391PubMedCrossRefGoogle Scholar
  18. 18.
    Kaab M, Stockle U, Schutz M et al (2006) Stabilisation of periprosthetic fractures with angular stable internal fixation: a report of 13 cases. Arch Orthop Trauma Surg 126:105–110PubMedCrossRefGoogle Scholar
  19. 19.
    Kenny P, Rice J, Quinlan W (1998) Interprosthetic fracture of the femoral shaft. J Arthroplasty 13:361–364PubMedCrossRefGoogle Scholar
  20. 20.
    Larson J, Chao E, Fitzgerald R (1991) Bypassing femoral cortical defects with cemented intramedullary stems. J Orthop Res 9:414–421PubMedCrossRefGoogle Scholar
  21. 21.
    Lehmann W, Rupprecht M, Hellmers N et al (2010) Biomechanical evaluation of peri- and interprosthetic fractures of the femur. J Trauma 68:1459–1463PubMedCrossRefGoogle Scholar
  22. 22.
    Lindahl H, Malchau H, Herberts P et al (2005) Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 20:857–865PubMedCrossRefGoogle Scholar
  23. 23.
    Lindahl H, Malchau H, Oden A et al (2006) Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br 88:26–30PubMedCrossRefGoogle Scholar
  24. 24.
    Mamczak C, Gardner M, Bolhofner B et al (2010) Interprosthetic femoral fractures. J Orthop Trauma 24:740–744PubMedCrossRefGoogle Scholar
  25. 25.
    Masri BA, Meek RM, Duncan CP (2004) Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 420:80–95PubMedCrossRefGoogle Scholar
  26. 26.
    Mclean A, Patton J, Moran M (2012) Femoral replacement for salvage of periprosthetic fracture around a total hip replacement. Injury 43:1166–1169PubMedCrossRefGoogle Scholar
  27. 27.
    Meek R, Norwood T, Smith R et al (2011) The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br 93:96–101PubMedCrossRefGoogle Scholar
  28. 28.
    Michla Y, Spalding L, Holland J et al (2010) The complex problem of the interprosthetic femoral fracture in the elderly patient. Acta Orthop Belg 76:636–643PubMedGoogle Scholar
  29. 29.
    Mukundan C, Rayan F, Kheir E et al (2010) Management of late periprosthetic femur fractures: a retrospective cohort of 72 patients. Int Orthop 34:485–489PubMedCrossRefGoogle Scholar
  30. 30.
    Pavlou G, Panteliadis P, Macdonald D et al (2011) A review of 202 periprosthetic fractures—stem revision and allograft improves outcome for type B fractures. Hip Int 21:21–29PubMedCrossRefGoogle Scholar
  31. 31.
    Platzer P, Schuster R, Luxl M et al (2011) Management and outcome of interprosthetic femoral fractures. Injury 42:1219–1225PubMedCrossRefGoogle Scholar
  32. 32.
    Rayan F, Konan S, Haddad F (2010) Uncemented revision hip arthroplasty in B2 and B3 periprosthetic femoral fractures—a prospective analysis. Hip Int 20:38–42PubMedGoogle Scholar
  33. 33.
    Rorabeck C, Taylor J (1999) Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin North Am 30:209–214PubMedCrossRefGoogle Scholar
  34. 34.
    Rorabeck C, Taylor J (1999) Periprosthetic fractures of the femur complicating total knee arthroplasty. Orthop Clin North Am 30:265–277PubMedCrossRefGoogle Scholar
  35. 35.
    Rupprecht M, Grossterlinden L, Barvencik F et al (2008) Periprosthetic fractures. Long-term results after plate osteosynthesis stabilization. Unfallchirurg 111:812–820PubMedCrossRefGoogle Scholar
  36. 36.
    Rupprecht M, Sellenschloh K, Grossterlinden L et al (2011) Biomechanical evaluation for mechanisms of periprosthetic femoral fractures. J Trauma 70:E62–66PubMedCrossRefGoogle Scholar
  37. 37.
    Sah A, Marshall A, Virkus W et al (2010) Interprosthetic fractures of the femur: treatment with a single-locked plate. J Arthroplasty 25:280–286PubMedCrossRefGoogle Scholar
  38. 38.
    Soenen M, Migaud H, Bonnomet F et al (2011) Interprosthetic femoral fractures: analysis of 14 cases. Proposal for an additional grade in the Vancouver and SoFCOT classifications. Orthop Traumatol Surg Res 97:693–698PubMedCrossRefGoogle Scholar
  39. 39.
    Su E, Dewal H, Di Cesare P (2004) Periprosthetic femoral fractures above total knee replacements. J Am Acad Orthop Surg 12:12–20PubMedGoogle Scholar
  40. 40.
    Tadross T, Nanu A, Buchanan M et al (2000) Dall-Miles plating for periprosthetic B1 fractures of the femur. J Arthroplasty 15:47–51PubMedCrossRefGoogle Scholar
  41. 41.
    Tsiridis E, Haddad F, Gie G (2003) The management of periprosthetic femoral fractures around hip replacements. Injury 34:95–105PubMedCrossRefGoogle Scholar
  42. 42.
    Tsiridis E, Krikler S, Giannoudis P (2007) Periprosthetic femoral fractures: current aspects of management. Injury 38:649–650PubMedCrossRefGoogle Scholar
  43. 43.
    Wahl B, Grasshoff H, Meinecke I et al (2001) Results of operative therapy of periprosthetic femur shaft fractures in total hip endoprostheses. Zentralbl Chir 126:50–54PubMedCrossRefGoogle Scholar
  44. 44.
    Xue H, Tu Y, Cai M et al (2011) Locking compression plate and cerclage band for type B1 periprosthetic femoral fractures preliminary results at average 30-month follow-up. J Arthroplasty 26(467–471):e461Google Scholar

Copyright information

© EFORT 2012

Authors and Affiliations

  • Björn Gunnar Ochs
    • 1
  • Ulrich Stöckle
    • 1
  • Florian Gebhard
    • 2
  1. 1.BG Trauma CentreTübingenGermany
  2. 2.Department of Trauma-, Hand- and Reconstructive SurgeryUniversity of UlmUlmGermany

Personalised recommendations