Abstract
Periprosthetic fractures of the femur require stem revision when the stem is loosened (Vancouver types B2 and B3 fractures) or the stem of the prosthesis is broken at the same time. In my opinion, it is also recommended as a procedural change in cases of failed plate osteosynthesis of a Vancouver type B1 fracture (with a firmly fixed stem). In this case, the exchange should be made to a cementless revision stem, whereby the new stem must be fixed below the fracture in the femur. In order to be able to perform this reliably, the proximal fragment should be accessed via a transfemoral approach (extended trochanteric osteotomy). If the isthmus is still intact (Vancouver type B2 fractures), this serves as the fixation site; if the isthmus is not intact (Vancouver type B3 fractures), additional fixation procedures such as distal interlocking are required. This chapter discusses the different surgical procedures involved.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Duncan DP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect. 1995;44:293–304.
Duncan CP, Haddad FS. The unified classification system (UCS): improving our understanding of periprosthetic fractures. Bone Joint J. 2014;96-B:713–6.
Beals RK, Tower SS. Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop. 1996;327:238–46.
Fink B, Fuerst M, Singer J. Periprosthetic fractures of the femur associated with hip arthroplasty. Arch Orthop Trauma Surg. 2005;125:433–42.
Haddad FS, Duncan CP, Berry DJ, Lewallen DG, Gross AE, Chandler HP. Periprosthetic femoral fractures around well-fixed implants: use of cortical onlay allografts with or without a plate. J Bone Joint Surg. 2002;84-A:945–50.
Tsiridis E, Haddad FS, Gie GA. Dal-Miles plates for periprosthetic femoral fractures. A critical review of 16 cases. Injury. 2003;34:107–10.
Adolphson P, Jonsson U, Kalen R. Fractures of the ipsilateral femur after total hip arthroplasty. Arch Orthop Trauma Surg. 1987;106:353–7.
Cooke PH, Newman JH. Fractures of the femur in relation to cemented hip prostheses. J Bone Joint Surg. 1988;70-B:386–9.
Namba RS, Rose NE, Amstutz HC. Unstable femoral fractures in hip arthroplasty. Orthop Trans. 1991;15:753.
Bethea JS, DeAndrade JR, Fleming LL, Lindenbaum SD, Welch RB. Proximal femoral fractures following total hip arthroplasty. Clin Orthop. 1982;170:95–106.
Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures form the Swedish National Hip Arthroplasty Register. J Arthroplasty. 2005;20:857–65.
Lindahl H, Garellick G, Regner H, et al. Three hundred an twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am. 2006;88-A:1215–22.
Abdel MP, Cotino U, Mabry TM. Management of periprosthetic femoral fractures following total hip arthroplasty. Int Orthop. 2015;39:2005–10.
Springer BD, Berry DJ, Lewallen DG. Treatment of periprosthetic femoral fractures following total hip arthroplasty with femoral component revision. J Bone Joint Surg Am. 2003;85-A:2156–62.
Kyle RF, Crickard GE III. Periprosthetic fractures associated with total hip arthroplasty. Orthopedics. 1998;21:982–4.
Jukkala-Partio K, Parito EK, Solovieva S, Paavilainen T, Hirvensalo E, Alho A. Treatment of periprosthetic fractures in association with total hip arthroplasty—a retrospective comparison between revision stem and plate fixation. Ann Chir Gyn. 1998;87:229–35.
Schmidt AH, Kyle RF. Periprosthetic fractures of the femur. Orthop Clin North Am. 2002;33:143–52.
Incavo SJ, Beard DM, Pupparo F, Ries M, Wiedel J. One-stage revision of periprosthetic fractures around loose cemented total hip arthroplasty. Am J Orthop. 1998;27:35–41.
Lewallen DG, Berry DJ. Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date. Instr Course Lect. 1998;47:243–9.
Sledge JB 3rd, Abiri A. An algorithm for the treatment of Vancouver type B2 periprosthetic proximal femoral fractures. J Arthroplasty. 2002;17:887–92.
Wang J-W, Wang C-J. Periprosthetic fracture of the femur after hip arthroplasty: the clinical outcome using cortical strut allografts. J Orthop Surg. 2000;8:27–31.
Weeden SH, Paprosky WG. Minimal 11-year follow-up of extensively porous-coated stems in femoral revision total hip arthroplasty. J Arthroplasty. 2002;17 Suppl:134–7.
Fink B, Grossman A, Schubring S, Schulz MS, Fuerst M. Short-term results of hip revisions with a curved cementless modular stem in association with the surgical approach. Arch Orthop Trauma Surg. 2009;129:65–73.
Tangsataporn S, Safir OA, Vincent AD, Abdelbary H, Gross AE, Kuzyk PRT. Risk factors for subsidence of a modular tapered femoral stem used for revision total hip arthroplasty. J Arthroplasty. 2015;30:1030–134.
Eingartner C, Volkmann R, Pütz M, Weller S. Uncemented revision stem for biological osteosynthesis in periprosthetic femoral fractures. Int Orthop. 1997;21:25–9.
Eingartner C, Ochs U, Egetemeyer D, Volkmann R. Treatment of periprosthetic femoral fractures with the Bicontact revision stem. Z Orthop Unfall. 2007;145:29–33.
Rasouli MR, Porat MD, Hozack WJ, Parvizi J. Proximal femoral replacement and allograft prosthesis composite in treatment of periprosthetic fractures with significant proximal bone loss. Orthop Surg. 2012;4:203–10.
Wong P, Gross AE. The use of structural allografts for treating periprosthetic fractures about the hip and knee. Orthop Clin North Am. 1999;30:259–64.
Kellett CF, Boscainos PJ, Maury AC, et al. Proximal femoral allograft treatment of Vancouver type-B3 periprosthetic femoral fractures after total hip arthroplasty. Surgical technique. J Bone Joint Surg Am. 2007;89-A(Suppl 2):S68–79.
Dorotka R, Windhager R, Kotz R. Periprosthetic femoral fractures in total hip prosthesis implantation. Functional and radiological comparison between plate osteosynthesis and proximal femur replacement. Z Orthop. 2000;138:440–6.
Wilson D, Masri BA, Duncan CP. Periprosthetic fractures: an operative algorithm. Orthopedics. 2001;24:869–70.
Klein GR, Parvizi J, Rapuri V, Wolf CF, Hozack WJ, Sharkey PF, Purtill JJ. Proximal femoral replacement for the treatment of periprosthetic fractures. J Bone Joint Surg Am. 2005;87-A:1777–81.
Aigner C, Marschall C, Reischl N, Windhager R. Cortical strut grafts, an alternative to conventional plating in periprosthetic fractures of the femur. Z Orthop. 2002;140:328–33.
Brady OH, Garbuz DS, Masri BA, Duncan CP. The treatment of periprosthetic fractures of the femur using cortical onlay allograft struts. Orthop Clin North Am. 1999;30:249–57.
Munro JT, Masri BA, Garbuz DS, Duncan CP. Tapered fluted modular titanium stems in the management of Vancouver B2 and B3 periprosthetic fractures. Bone Joint J. 2013;95-B(Suppl A):17–20.
Munro JT, Garbuz DS, Masri BA, Duncan CP. Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures. Clin Orthop Relat Res. 2014;472:590–8.
Kahn T, Grindlay D, Olliviere BJ, Scammell BE, Manktelow ARJ, Pearson RG. A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Joint J. 2017;4(Suppl B):17–25.
O’Shea K, Quinlan JF, Kutty S, Mulcahy D, Brady OH. The use of uncemented extensively porous-coated femoral components in the management of Vancouver B2 and B3 periprosthetic femoral fractures. J Bone Joint Surg Br. 2005;87-B:1617–21.
Moran MC. Treatment of periprosthetic fractures around total hip arthroplasty with an extensively coated femoral component. J Arthroplasty. 1996;11:981–8.
Ko PS, Lam JJ, Tio MK, Lee OB, Ip FK. Distal fixation with Wagner revision stem in treating Vancouver type B2 periprosthetic femur fractures in geriatric patients. J Arthroplasty. 2003;13:446–52.
Levine BR, Della Valle CJ, Lewis P, Berger RA, Sporer SM, Paprosky W. Extended trochanteric osteotomy for the treatment of Vancouver B2/B3 periprosthetic fractures of the femur. J Arthroplasty. 2008;23:527–33.
Park M-S, Lim Y-J, Chung W-C, Ham D-H, Lee S-H. Management of periprosthetic femur fractures treated with distal fixation using a modular femoral stem using an anterolateral approach. J Arthroplasty. 2009;24:1270–6.
Mulay S, Hassan T, Birtwistle S, Power R. Management of types B2 and B3 femoral periprosthetic fractures by a tapered, fluted, and distally fixed stem. J Arthroplasty. 2005;20:751–6.
Neumann D, Thaler C, Dorn U. Management of Vancouver B2 and B3 femoral periprosthetic fractures using a modular cementless stem without allografting. Int Orthop. 2012;36:1045–50.
Fink B, Grossmann A, Singer J. Hip revision arthroplasty in periprosthetic fractures of Vancouver type B2 and B3. J Orthop Trauma. 2012;26:206–11.
Amenabar T, Rahman WA, Avhad VV, Vera R, Gross AE, Kuzyk PR. Vancouver type B2 and B3 periprosthetic fractures treated with revision total hip arthroplasty. Int Orthop. 2015;39:1927–32.
Van Laarhoven SN, Vles GF, van Haaren EH, Schotanus MGM, van Hemert WLW. Tapered, fluted, modular, titanium stems in Vancouver B periprosthetic femoral fractures: an analysis of 87 consecutive revisions. Hip Int. 2021;31(4):555–61. https://doi.org/10.1177/1120700020904933.
Fink B. Revision arthroplasty in periprosthetic fractures of the proximal femur. Oper Orthop Traumatol. 2014;26:455–68.
Paprosky WG, Greidanus NV, Antoniou J. Minimum 10-year results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res. 1999;369:230–42.
Engh CA, Glassman AH, Suthers KE. The case of porous-coated hip implants: the femoral side. Clin Orthop Relat Res. 1990;261:63–81.
Boesmmueller S, Baumbach S, Hofbauer M, Wozasek GE. Plate failure following plate osteosynthesis in periprosthetic femoral fractures. Wien Klin Wochenschr. 2015;127:770–8.
Lindahl H, Malchau H, Oden A, Garellick G. Risk factors for failure after treatment of a periprosthetic of the femur. J Bone Joint Surg Br. 2006;88:26–30.
Dehghan N, McKee MD, Nuth A, Ristevski B, Schemitsch EH. Surgical fixation of Vancouver type B1 periprosthetic femur fractures: a systematic review. J Orthop Trauma. 2014;28:721–7.
Frohberg L, Troelsen A, Brix M. Periprosthetic Vancouver type B1 and C fractures treated by locking-plate osteosynthesis. Fracture union and reoperations in 60 consecutive fractures. Acta Orthop. 2012;83:648–52.
Graham SM, Moazen M, Leonidou A, Tsiridis E. Locking plate fixation for Vancouver B1 periprosthetic femoral fractures: a critical analysis in 135 cases. J Orthop Sci. 2013;18:426–36.
Moloney GB, Westrick ER, Siska PA, Tarkin IS. Treatment of periprosthetic femur fractures around a well-fixed hip arthroplasty implant: span the whole bone. Arch Orthop Trauma Surg. 2014;134:9–14.
Leonidou A, Moazen M, Lepetsos P, Graham SM, Macheras GA, Tsiridis E. The biomechanical effect of bone quality and fracture topography on locking plate fixation in periprosthetic femoral fractures. Injury. 2015;46:213–7.
Laurer HL, Wutzler S, Possner S, Geiger EV, Saman AE, Marzi I, Frank J. Outcome after operative treatment of Vancouver type B and C periprosthetic fractures: open reduction and internal fixation versus revision arthroplasty. Arch Orthop Trauma Surg. 2011;131:983–9.
Moazen M, Mak JH, Etchels LW, Jin Z, Wilcox RK, Jones AC, Tsiridis E. Periprosthetic femoral fractures—a biomechanical comparison between Vancouver type B1 and B2 fixation methods. J Arthroplasty. 2014;29:495–500.
Fink B, Oremek D. Hip revision arthroplasty for failed osteosynthesis in periprosthetic Vancouver B1 fractures using a cementless, tapered, modular revision stem. Bone Joint J. 2017;99-B(4 Suppl B):11–6.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Fink, B. (2022). Stem Revision in Periprosthetic Fractures. In: Femoral Revision Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-030-84821-7_18
Download citation
DOI: https://doi.org/10.1007/978-3-030-84821-7_18
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-84820-0
Online ISBN: 978-3-030-84821-7
eBook Packages: MedicineMedicine (R0)