Skip to main content

Stem Revision in Periprosthetic Fractures

  • 84 Accesses

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.

Keywords

  • Periprosthetic fracture
  • Femoral revision
  • Revision stem
  • Transfemoral approach
  • Extended trochanteric osteotomy
  • Vancouver classification
  • Unified classification system

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-84821-7_18
  • Chapter length: 15 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   149.00
Price excludes VAT (USA)
  • ISBN: 978-3-030-84821-7
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Hardcover Book
USD   199.99
Price excludes VAT (USA)
Fig. 18.1
Fig. 18.2
Fig. 18.3
Fig. 18.4
Fig. 18.5
Fig. 18.6

References

  1. Duncan DP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect. 1995;44:293–304.

    CAS  Google Scholar 

  2. Duncan CP, Haddad FS. The unified classification system (UCS): improving our understanding of periprosthetic fractures. Bone Joint J. 2014;96-B:713–6.

    CAS  Google Scholar 

  3. Beals RK, Tower SS. Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop. 1996;327:238–46.

    Google Scholar 

  4. Fink B, Fuerst M, Singer J. Periprosthetic fractures of the femur associated with hip arthroplasty. Arch Orthop Trauma Surg. 2005;125:433–42.

    PubMed  Google Scholar 

  5. 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.

    Google Scholar 

  6. Tsiridis E, Haddad FS, Gie GA. Dal-Miles plates for periprosthetic femoral fractures. A critical review of 16 cases. Injury. 2003;34:107–10.

    PubMed  Google Scholar 

  7. Adolphson P, Jonsson U, Kalen R. Fractures of the ipsilateral femur after total hip arthroplasty. Arch Orthop Trauma Surg. 1987;106:353–7.

    CAS  PubMed  Google Scholar 

  8. Cooke PH, Newman JH. Fractures of the femur in relation to cemented hip prostheses. J Bone Joint Surg. 1988;70-B:386–9.

    Google Scholar 

  9. Namba RS, Rose NE, Amstutz HC. Unstable femoral fractures in hip arthroplasty. Orthop Trans. 1991;15:753.

    Google Scholar 

  10. Bethea JS, DeAndrade JR, Fleming LL, Lindenbaum SD, Welch RB. Proximal femoral fractures following total hip arthroplasty. Clin Orthop. 1982;170:95–106.

    Google Scholar 

  11. 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.

    PubMed  Google Scholar 

  12. 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.

    Google Scholar 

  13. Abdel MP, Cotino U, Mabry TM. Management of periprosthetic femoral fractures following total hip arthroplasty. Int Orthop. 2015;39:2005–10.

    PubMed  Google Scholar 

  14. 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.

    Google Scholar 

  15. Kyle RF, Crickard GE III. Periprosthetic fractures associated with total hip arthroplasty. Orthopedics. 1998;21:982–4.

    CAS  PubMed  Google Scholar 

  16. 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.

    CAS  Google Scholar 

  17. Schmidt AH, Kyle RF. Periprosthetic fractures of the femur. Orthop Clin North Am. 2002;33:143–52.

    PubMed  Google Scholar 

  18. 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.

    CAS  PubMed  Google Scholar 

  19. 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.

    CAS  PubMed  Google Scholar 

  20. Sledge JB 3rd, Abiri A. An algorithm for the treatment of Vancouver type B2 periprosthetic proximal femoral fractures. J Arthroplasty. 2002;17:887–92.

    PubMed  Google Scholar 

  21. 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.

    CAS  Google Scholar 

  22. 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.

    Google Scholar 

  23. 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.

    PubMed  Google Scholar 

  24. 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.

    PubMed  Google Scholar 

  25. Eingartner C, Volkmann R, Pütz M, Weller S. Uncemented revision stem for biological osteosynthesis in periprosthetic femoral fractures. Int Orthop. 1997;21:25–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. 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.

    Google Scholar 

  27. 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.

    PubMed  PubMed Central  Google Scholar 

  28. 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.

    CAS  PubMed  Google Scholar 

  29. 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.

    Google Scholar 

  30. 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.

    CAS  PubMed  Google Scholar 

  31. Wilson D, Masri BA, Duncan CP. Periprosthetic fractures: an operative algorithm. Orthopedics. 2001;24:869–70.

    CAS  PubMed  Google Scholar 

  32. 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.

    Google Scholar 

  33. 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.

    CAS  PubMed  Google Scholar 

  34. 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.

    CAS  PubMed  Google Scholar 

  35. 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.

    CAS  PubMed  Google Scholar 

  36. 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.

    PubMed  Google Scholar 

  37. 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.

    Google Scholar 

  38. 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.

    Google Scholar 

  39. Moran MC. Treatment of periprosthetic fractures around total hip arthroplasty with an extensively coated femoral component. J Arthroplasty. 1996;11:981–8.

    CAS  PubMed  Google Scholar 

  40. 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.

    Google Scholar 

  41. 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.

    PubMed  Google Scholar 

  42. 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.

    PubMed  Google Scholar 

  43. 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.

    PubMed  Google Scholar 

  44. 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.

    PubMed  Google Scholar 

  45. 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.

    PubMed  Google Scholar 

  46. 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.

    PubMed  Google Scholar 

  47. 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.

    CrossRef  PubMed  Google Scholar 

  48. Fink B. Revision arthroplasty in periprosthetic fractures of the proximal femur. Oper Orthop Traumatol. 2014;26:455–68.

    CAS  PubMed  Google Scholar 

  49. 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.

    Google Scholar 

  50. Engh CA, Glassman AH, Suthers KE. The case of porous-coated hip implants: the femoral side. Clin Orthop Relat Res. 1990;261:63–81.

    Google Scholar 

  51. Boesmmueller S, Baumbach S, Hofbauer M, Wozasek GE. Plate failure following plate osteosynthesis in periprosthetic femoral fractures. Wien Klin Wochenschr. 2015;127:770–8.

    Google Scholar 

  52. 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.

    CAS  Google Scholar 

  53. 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.

    Google Scholar 

  54. 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.

    Google Scholar 

  55. 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.

    PubMed  Google Scholar 

  56. 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.

    PubMed  Google Scholar 

  57. 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.

    PubMed  Google Scholar 

  58. 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.

    PubMed  Google Scholar 

  59. 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.

    PubMed  Google Scholar 

  60. 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.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bernd Fink .

Rights and permissions

Reprints and Permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

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)