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Periprosthetic Fracture of the Femur After Total Hip Arthroplasty

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Complications after Primary Total Hip Arthroplasty

Abstract

Periprosthetic femoral fractures may occur intraoperatively, early or late postoperatively. Risk factors include fracture as primary diagnosis for arthroplasty, osteolysis, loose implants, and revision surgery. Prevention of intraoperative fractures begins with careful preoperative planning, identifying at-risk patients, and attention to surgical technique. For patients presenting with fractures after hip arthroplasty, obtaining a thorough history is important to rule out implant loosening prior to the injury. Minimally displaced fractures of the greater trochanter (type A fractures) are best treated conservatively. Fractures around a well-fixed implant (type B1 fractures) are treated with plating with combined proximal cables and unicortical screws and distal bicortical screws, with or without strut allografts. When the stability of the implant is questionable, it must be tested intraoperatively. Fractures around a loose implant (type B2 fractures) must be treated with stem revision to a stem that gains primary fixation in the diaphysis. Fractures in the setting of deficient bone stock (type B3 fractures) can be challenging to treat. Surgical options include long cylindrical or fluted stems, with or without cortical strut grafting, allograft-prosthetic composite, or proximal femoral replacement. Currently, the overwhelming majority of type B2 and B3 fractures are treated with modern modular fluted tapered stems. Fractures well distal to the implant (type C fractures) are best treated with open reduction and internal fixation extending proximally above the tip of the stem.

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References

  1. Horwitz IB, Lenobel MI. Artificial hip prosthesis in acute and nonunion fractures of the femoral neck: follow-up study of seventy cases. J Am Med Assoc. 1954;155(6):564–7.

    Article  CAS  PubMed  Google Scholar 

  2. Parrish TF, Jones JR. Fracture of the femur following prosthetic arthroplasty of the hip. Report of nine cases. J Bone Joint Surg Am. 1964;46:241–8.

    Article  CAS  PubMed  Google Scholar 

  3. Charnley J. The healing of human fractures in contact with self-curing acrylic cement. Clin Orthop Relat Res. 1966;47:157–63.

    Article  CAS  PubMed  Google Scholar 

  4. Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007;38(6):651–4.

    Article  PubMed  Google Scholar 

  5. Cook RE, et al. Risk factors for periprosthetic fractures of the hip: a survivorship analysis. Clin Orthop Relat Res. 2008;466(7):1652–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Thien TM, et al. Periprosthetic femoral fracture within two years after total hip replacement analysis of 437,629 operations in the Nordic Arthroplasty Register Association Database. J Bone Joint Surg Am. 2014;96A(19):e167.

    Article  Google Scholar 

  7. Schwartz Jr JT, Mayer JG, Engh CA. Femoral fracture during non-cemented total hip arthroplasty. J Bone Joint Surg Am. 1989;71(8):1135–42.

    Article  PubMed  Google Scholar 

  8. Abdel MP, et al. Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Joint J. 2016;98-B(4):461–7.

    Article  CAS  PubMed  Google Scholar 

  9. Berry DJ. Epidemiology: hip and knee. Orthop Clin North Am. 1999;30(2):183–90.

    Article  CAS  PubMed  Google Scholar 

  10. Lindahl H, et al. Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am. 2006;88(6):1215–22.

    PubMed  Google Scholar 

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

    Article  Google Scholar 

  12. Sarvilinna R, et al. Factors predisposing to periprosthetic fracture after hip arthroplasty: a case (n = 31)-control study. Acta Orthop Scand. 2004;75(1):16–20.

    Article  PubMed  Google Scholar 

  13. Franklin J, Malchau H. Risk factors for periprosthetic femoral fracture. Injury. 2007;38(6):655–60.

    Article  PubMed  Google Scholar 

  14. Berry DJ. Periprosthetic fractures associated with osteolysis: a problem on the rise. J Arthroplast. 2003;18(3 Suppl 1):107–11.

    Article  Google Scholar 

  15. Incavo SJ, et al. One-stage revision of periprosthetic fractures around loose cemented total hip arthroplasty. Am J Orthop (Belle Mead NJ). 1998;27(1):35–41.

    CAS  Google Scholar 

  16. Tsiridis E, Haddad FS, Gie GA. The management of periprosthetic femoral fractures around hip replacements. Injury. 2003;34(2):95–105.

    Article  PubMed  Google Scholar 

  17. Harris B, et al. Does femoral component loosening predispose to femoral fracture?: an in vitro comparison of cemented hips. Clin Orthop Relat Res. 2010;468(2):497–503.

    Article  PubMed  Google Scholar 

  18. Katz JN, et al. Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study. BMC Musculoskelet Disord. 2014;15:168.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Meek RM, et al. Intraoperative fracture of the femur in revision total hip arthroplasty with a diaphyseal fitting stem. J Bone Joint Surg Am. 2004;86-A(3):480–5.

    Article  PubMed  Google Scholar 

  20. Watts CD, et al. Increased risk of periprosthetic femur fractures associated with a unique cementless stem design. Clin Orthop Relat Res. 2015;473(6):2045–53.

    Article  PubMed  Google Scholar 

  21. Lindahl H, et al. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplast. 2005;20(7):857–65.

    Article  Google Scholar 

  22. Shah RP, et al. Diagnosing infection in the setting of periprosthetic fractures. J Arthroplast. 2016;31(9 Suppl):140–3.

    Article  Google Scholar 

  23. Schwarzkopf R, Oni JK, Marwin SE. Total hip arthroplasty periprosthetic femoral fractures: a review of classification and current treatment. Bull Hosp Jt Dis (2013). 2013;71(1):68–78.

    Google Scholar 

  24. Brady OH, et al. Classification of the hip. Orthop Clin North Am. 1999;30(2):215–20.

    Article  CAS  PubMed  Google Scholar 

  25. Pike J, et al. Principles of treatment for periprosthetic femoral shaft fractures around well-fixed total hip arthroplasty. J Am Acad Orthop Surg. 2009;17(11):677–88.

    Article  PubMed  Google Scholar 

  26. McElfresh EC, Coventry MB. Femoral and pelvic fractures after total hip arthroplasty. J Bone Joint Surg Am. 1974;56(3):483–92.

    Article  CAS  PubMed  Google Scholar 

  27. Lindahl H, et al. Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br. 2006;88(1):26–30.

    Article  CAS  PubMed  Google Scholar 

  28. Schmotzer H, Tchejeyan GH, Dall DM. Surgical management of intra- and postoperative fractures of the femur about the tip of the stem in total hip arthroplasty. J Arthroplast. 1996;11(6):709–17.

    Article  CAS  Google Scholar 

  29. Berman AT, Zamarin R. The use of Dall-Miles cables in total hip arthroplasty. Orthopedics. 1993;16(7):833–5.

    CAS  PubMed  Google Scholar 

  30. Haddad FS, Marston RA, Muirhead-Allwood SK. The Dall-Miles cable and plate system for periprosthetic femoral fractures. Injury. 1997;28(7):445–7.

    Article  CAS  PubMed  Google Scholar 

  31. Sandhu R, Avramidis K, Johnson-Nurse C. Dall-Miles cable and plate fixation system in the treatment of periprosthetic femoral fractures: a review of 20 cases. J Orthop Surg (Hong Kong). 2005;13(3):259–66.

    Article  CAS  Google Scholar 

  32. Giannoudis PV, Kanakaris NK, Tsiridis E. Principles of internal fixation and selection of implants for periprosthetic femoral fractures. Injury. 2007;38(6):669–87.

    Article  PubMed  Google Scholar 

  33. Dennis MG, et al. Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques. J Arthroplast. 2000;15(4):523–8.

    Article  CAS  Google Scholar 

  34. Tsiridis E, Haddad FS, Gie GA. Dall-Miles plates for periprosthetic femoral fractures. A critical review of 16 cases. Injury. 2003;34(2):107–10.

    Article  PubMed  Google Scholar 

  35. Courpied JP, Watin-Augouard L, Postel M. Femoral fractures in subjects with total prostheses of the hip or knee. Int Orthop. 1987;11(2):109–15.

    Article  CAS  PubMed  Google Scholar 

  36. Serocki JH, Chandler RW, Dorr LD. Treatment of fractures about hip prostheses with compression plating. J Arthroplast. 1992;7(2):129–35.

    Article  CAS  Google Scholar 

  37. Ricci WM, et al. Indirect reduction and plate fixation, without grafting, for periprosthetic femoral shaft fractures about a stable intramedullary implant. J Bone Joint Surg Am. 2005;87(10):2240–5.

    PubMed  Google Scholar 

  38. Fulkerson E, et al. Fixation of periprosthetic femoral shaft fractures associated with cemented femoral stems: a biomechanical comparison of locked plating and conventional cable plates. J Orthop Trauma. 2006;20(2):89–93.

    Article  PubMed  Google Scholar 

  39. Dehghan N, et al. Surgical fixation of Vancouver type B1 periprosthetic femur fractures: a systematic review. J Orthop Trauma. 2014;28(12):721–7.

    Article  PubMed  Google Scholar 

  40. Haddad FS, et al. Periprosthetic femoral fractures around well-fixed implants: use of cortical onlay allografts with or without a plate. J Bone Joint Surg Am. 2002;84-A(6):945–50.

    Article  PubMed  Google Scholar 

  41. Emerson Jr RH, et al. Cortical strut allografts in the reconstruction of the femur in revision total hip arthroplasty. A basic science and clinical study. Clin Orthop Relat Res. 1992;285:35–44.

    Google Scholar 

  42. Chandler HP, Tigges RG. The role of allografts in the treatment of periprosthetic femoral fractures. Instr Course Lect. 1998;47:257–64.

    CAS  PubMed  Google Scholar 

  43. Corten K, et al. An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component. J Bone Joint Surg Br. 2009;91(11):1424–30.

    Article  CAS  PubMed  Google Scholar 

  44. Buttaro MA, et al. Locking compression plate fixation of Vancouver type-B1 periprosthetic femoral fractures. J Bone Joint Surg Am. 2007;89(9):1964–9.

    CAS  PubMed  Google Scholar 

  45. Wood GC, et al. Locking compression plates for the treatment of periprosthetic femoral fractures around well-fixed total hip and knee implants. J Arthroplast. 2011;26(6):886–92.

    Article  Google Scholar 

  46. O’Shea K, et al. 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(12):1617–21.

    Article  PubMed  Google Scholar 

  47. Ko PS, et al. Distal fixation with Wagner revision stem in treating Vancouver type B2 periprosthetic femur fractures in geriatric patients. J Arthroplast. 2003;18(4):446–52.

    Article  CAS  Google Scholar 

  48. Berry DJ. Treatment of Vancouver B3 periprosthetic femur fractures with a fluted tapered stem. Clin Orthop Relat Res. 2003;417:224–31.

    Google Scholar 

  49. Munro JT, et al. Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures. Clin Orthop Relat Res. 2014;472(2):590–8.

    Article  PubMed  Google Scholar 

  50. 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(11):2156–62.

    Article  PubMed  Google Scholar 

  51. Abdel MP, Lewallen DG, Berry DJ. Periprosthetic femur fractures treated with modular fluted, tapered stems. Clin Orthop Relat Res. 2014;472(2):599–603.

    Article  PubMed  Google Scholar 

  52. Blackley HR, et al. Proximal femoral allografts for reconstruction of bone stock in revision arthroplasty of the hip. A nine to fifteen-year follow-up. J Bone Joint Surg Am. 2001;83-A(3):346–54.

    Article  CAS  PubMed  Google Scholar 

  53. Haddad FS, et al. Structural proximal femoral allografts for failed total hip replacements: a minimum review of five years. J Bone Joint Surg Br. 2000;82(6):830–6.

    Article  CAS  PubMed  Google Scholar 

  54. Klein GR, et al. Proximal femoral replacement for the treatment of periprosthetic fractures. J Bone Joint Surg Am. 2005;87(8):1777–81.

    PubMed  Google Scholar 

  55. Levine BR, et al. Extended trochanteric osteotomy for the treatment of vancouver B2/B3 periprosthetic fractures of the femur. J Arthroplast. 2008;23(4):527–33.

    Article  Google Scholar 

  56. Ehlinger M, et al. Type C periprosthetic fractures treated with locking plate fixation with a mean follow up of 2.5 years. Orthop Traumatol Surg Res. 2010;96(1):44–8.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Khalid Azzam MD & R. Michael Meneghini MD

  2. Indiana University Department of Orthopedics, Indiana University Health Saxony Hospital, 13100 E 136th St., Suite 2000, Fishers, IN, 46037, USA

    Khalid Azzam MD & R. Michael Meneghini MD

Authors
  1. Khalid Azzam MD
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  2. R. Michael Meneghini MD
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Correspondence to Khalid Azzam MD .

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Editors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA

    Matthew P. Abdel

  2. Division of Adult Reconstruction, Rush University Medical Center, Chicago, Illinois, USA

    Craig J. Della Valle

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Azzam, K., Meneghini, R.M. (2017). Periprosthetic Fracture of the Femur After Total Hip Arthroplasty. In: Abdel, M., Della Valle, C. (eds) Complications after Primary Total Hip Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-54913-2_11

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  • DOI: https://doi.org/10.1007/978-3-319-54913-2_11

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