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Periprosthetic fractures of the femur associated with hip arthroplasty

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Abstract

The nature of the treatment of periprosthetic fractures depends on the localisation, the stability of the prosthesis and the condition of the bone. The Vancouver fracture classification has proved to be of value in determining specific modes of treatment. The current review analyses the different therapeutic options resulting in a concept of fracture-specific treatment. In this report we propose an extended version of this classification in which periprosthetic fractures associated with endoprostheses anchored in the epiphysis or metaphysis, as well as interprosthetic fractures, are taken into consideration.

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References

  1. Adolphson P, Jonsson U, Kalen R (1987) Fractures of the ipsilateral femur after total hip arthroplasty. Arch Orthop Trauma Surg 106:353–357

    Article  PubMed  CAS  Google Scholar 

  2. Ahuja S, Chatterji S (2002) The Mennen femoral plate for fixation of periprosthetic femoral fractures following hip arthroplasty. Injury 33:47–50

    Article  PubMed  Google Scholar 

  3. Aigner C, Marschall C, Reischl N, Windhager R (2002) Cortical strut grafts, an alternative to conventional plating in periprosthetic fractures of the femur. Z Orthop 140:328–333

    Article  PubMed  CAS  Google Scholar 

  4. Beals RK, Tower SS (1996) Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop 327:238–246

    Article  PubMed  Google Scholar 

  5. Bernd L, Blasius K, Cotta H (1989) Possibilities of therapy of femur fractures following placement of a total hip endoprosthesis. Z Orthop 127:291–295

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  7. Blatter G, Fiechter T, Magerl F (1989) Fractures of the ipsilateral femur after total hip arthroplasty. Orthopade 18:545–551

    PubMed  CAS  Google Scholar 

  8. Brady OH, Garbuz DS, Masri BA, Duncan CP (1999) The treatment of periprosthetic fractures of the femur using cortical onlay allograft struts. Orthop Clin North Am 30:249–257

    Article  PubMed  CAS  Google Scholar 

  9. Chandler HP, King D, Limbird R, Hedley A, McCarthy J, Penenberg B, Danylchuk K (1993) The use of cortical allograft struts for fixation of fractures associated with well-fixed total joint prostheses. Semin Arthroplasty 4:99–107

    PubMed  CAS  Google Scholar 

  10. Cooke PH, Newman JH (1988) Fractures of the femur in relation to cemented hip prostheses. J Bone Joint Surg 70-B:386–389

    CAS  Google Scholar 

  11. Dall DM, Miles AW (1983) Re-attachment of the greater trochanter. The use of the trochanter cable-grip system. J Bone Joint Surg 65-B:55–59

    Google Scholar 

  12. Dennis MG, Simon JA, Kummer FJ, Koval KJ, DiCesare PE (2000) Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem. A biomechanical study of 5 techniques. J Arthroplasty 15:523–528

    Article  PubMed  CAS  Google Scholar 

  13. Dennis MG, Simon JA, Kimmer FJ, Koval KJ, DiCesare PE (2001) Fixation of periprosthetic femoral shaft fractures: a biomechanical comparison of two techniques. J Orthop Trauma 15:177–180

    Article  PubMed  CAS  Google Scholar 

  14. Dorotka R, Windhager R, Kotz R (2000) Periprosthetic femoral fractures in total hip prosthesis implantation. Functional and radiological comparison between plate osteosynthesis and proximal femur replacement. Z Orthop 138:440–446

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  16. Eingartner C, Volkmann R, Pütz M, Weller S (1997) Uncemented revision stem for biological osteosynthesis in periprosthetic femoral fractures. Int Orthop 21:25–29

    Article  PubMed  CAS  Google Scholar 

  17. Emerson RH Jr, Malinin TI, Cuellar AD, Head WC, Peters PC (1992) Cortical strut allografts in the reconstruction of the femur in revision total hip arthroplasty. A basic science and clinical study. Clin Orthop 285:35–44

    PubMed  Google Scholar 

  18. Emerson RH Jr, Head WC, Higgins LL (2001) A new method of trochanteric fixation after osteotomy in revision total hip arthroplasty with a calcar replacement femoral component. J Arthroplasty 16 [Suppl 1]:76–80

    Article  PubMed  Google Scholar 

  19. Fink B, Wessel S, Protzen M, Rüther W (2003) Mid-term results of the thrust-plate prosthesis. Z Orthop 141 [Suppl]:S61

    Google Scholar 

  20. Garcia-Cimbrelo E, Munuera L, Gil-Garay E (1992) Femoral shaft fractures after cemented total hip arthroplasty. Int Orthop 16:97–100

    Article  PubMed  CAS  Google Scholar 

  21. Gill TJ, Sledge JB, Orler R, Ganz R (1999) Lateral insufficiency fractures of the femur caused by osteopenia and varus angulation: a complication of total hip arthroplasty. J Arthroplasty 14:982–987

    Article  PubMed  CAS  Google Scholar 

  22. Grabuz DS, Masri BA, Duncan CP (1998) Periprosthetic fractures of the femur: principles of prevention and management. Instr Course Lect 47:237–242

    Google Scholar 

  23. Haddad FS, Marston RA, Muirhead-Allwood SK (1997) The Dall-Miles cable and plate system for periprosthetic femoral fractures. Injury 28:445–447

    Article  PubMed  CAS  Google Scholar 

  24. Haddad FS, Duncan CP, Berry DJ, Lewallen DG, Gross AE, Chandler HP (2002) Periprosthetic femoral fractures around well-fixed implants: use of cortical onlay allografts with or without a plate. J Bone Joint Surg 84A:945–950

    PubMed  Google Scholar 

  25. Hawkins A, Midwinter K, MacDonald DA (2000) Trochanteric non-union in revision total hip arthroplasty: do it matter? Ann R Coll Surg Engl 82:39–42

    PubMed  CAS  Google Scholar 

  26. Head WC, Malinin TI, Mallory TH, Emerson RH Jr (1998) Onlay cortical allografting for the femur. Orthop Clin North Am 29:307–312

    Article  PubMed  CAS  Google Scholar 

  27. Incavo SJ, Beard DM, Pupparo F, Ries M, Wiedel J (1998) One-stage revision of periprosthetic fractures around loose cemented total hip arthroplasty. Am J Orthop 27:35–41

    PubMed  CAS  Google Scholar 

  28. Jensen JS, Barfod G, Hansen D et al (1988) Femoral shaft fracture after hip arthroplasty. Acta Orthop Scand 59:9–13

    PubMed  CAS  Google Scholar 

  29. Johansson JE, McBroom R, Barrington TW, Hunter GA (1981) Fracture of the ipsilateral femur in patients with total hip replacement. J Bone Joint Surg 63A:1435–1442

    PubMed  CAS  Google Scholar 

  30. Jukkala-Partio K, Parito EK, Solovieva S, Paavilainen T, Hirvensalo E, Alho A (1998) Treatment of periprosthetic fractures in association with total hip arthroplasty—a retrospective comparison between revision stem and plate fixation. Ann Chir Gynaecol 87:229–235

    PubMed  CAS  Google Scholar 

  31. Kamineni S, Ware HE (1999) The Mennen plate: unsuitable for elderly femoral periprosthetic fractures. Injury 30:257–260

    Article  PubMed  CAS  Google Scholar 

  32. Kelley SS (1994) Periprosthetic femoral fractures. J Am Acad Orthop Surg 2:164–172

    PubMed  Google Scholar 

  33. Kenny P, Quinlan W (1998) Interprosthetic fracture of the femoral shaft. J Arthroplasty 13:361–364

    Article  PubMed  CAS  Google Scholar 

  34. Kolb W, Guhlmann H, Friedel R, Nestmann H (2003) Fixation of periprosthetic femur fractures with the less invasive stabilization system (LISS)—a new minimally invasive treatment with locked fixed-angle screws. Zentralbl Chir 128:53–59

    Article  PubMed  CAS  Google Scholar 

  35. Kolstad K (1994) Revision THR after periprosthetic femoral fractures. An analysis of 23 cases 65:505–508

    CAS  Google Scholar 

  36. Kyle RF, Crickard GE III (1998) Periprosthetic fractures associated with total hip arthroplasty. Orthopedics 21:982–984

    PubMed  CAS  Google Scholar 

  37. Lam SJS, Purkayastha S (1993) The Mennen plate. A unique indication for internal fixation. CMW Laboratories, Dentsply, England

    Google Scholar 

  38. Larson JE, Chao EY, Fitzgerald RH (1991) By-passing femoral cortical defects with cemented intra-medullary stems. J Orthop Res 9:414–421

    Article  PubMed  CAS  Google Scholar 

  39. Logel KJ, Lachiewicz PF, Schmale GA, Kelley SS (1999) Cortical strut allografts for thr treatment of femoral fractures and deficiencies in revision total hip arthroplasty. J South Orthop Assoc 8:163–172

    PubMed  CAS  Google Scholar 

  40. MacDonald SJ, Paprosky WG, Jablonsky WS, Magnus RG (2001) Periprosthetic femoral fractures treated with a long-stem cementless component. J Arthroplasty 16:379–383

    Article  PubMed  CAS  Google Scholar 

  41. Magnus RE, Paprosky WG, Jablonsky W (1993) Cementless revision of unstable femoral prostheses associated with proximal femoral fractures. Orthop Trans 17:602–606

    Google Scholar 

  42. Malinin T, Latta LL, Wagner JL, Brown MD (1984) Healing of fractures with freeze-dried cortical bone plates. Comparison with compression plating. Clin Orthop 190:281–286

    PubMed  Google Scholar 

  43. Mihalko WM, Beaudoin AJ, Cardea JA, Krause WR (1992) Finite-element modelling of femoral shaft fracture fixation techniques post total hip arthroplasty. J Biomech 25:469–476

    Article  PubMed  CAS  Google Scholar 

  44. Mont MA, Maar DC (1994) Fractures of the ipsilateral femur after hip arthroplasty. A statistical analysis of outcome based on 487 patients. J Arthroplasty 9:511–519

    CAS  Google Scholar 

  45. Montijo H, Ebert FR, Lennox DA (1989) Treatment of proximal femur fractures associated with total hip arthroplasty. J Arthroplasty 4:115–123

    Article  PubMed  CAS  Google Scholar 

  46. Moran MC (1996) Treatment of periprosthetic fractures around total hip arthroplasty with an extensively coated femoral component. J Arthroplasty 11:981–988

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

  48. Nicholson P, Mulcahy D, Fenelon G (2001) Trochanteric union in revision hip arthroplasty. J Arthroplasty 16:65–69

    Article  PubMed  CAS  Google Scholar 

  49. Noorda RJP, Wuisman PIJM (2002) Mennen plate fixation for the treatment of periprosthetic femoral fractures. A multicenter study of thirty-six fractures. J Bone Joint Surg 84A:2211–2215

    PubMed  Google Scholar 

  50. Ogden W, Rendall J (1978) Fractures beneath hip prosthesis: a special indication for Parham bands and plating. Orthop Trans 2:70

    Google Scholar 

  51. Otremski I, Nusam I, Glickman M, Newman RJ (1998) Mennen paraskeletal plate fixation for fracture of the femoral shaft in association with ipsilateral hip arthroplasty. Injury 29:421–423

    Article  PubMed  CAS  Google Scholar 

  52. Partridge AJ, Evans PE (1982) The treatment of fractures of the shaft of the femur using nylon cerclage. J Bone Joint Surg 64B:210–214

    CAS  Google Scholar 

  53. Radcliffe SN, Smith DN (1996) The Mennen plate in periprosthetic hip fractures. Injury 27:27–30

    Article  PubMed  CAS  Google Scholar 

  54. Ries MD (1997) Periprosthetic fractures: early and late. Orthopedics 20:798–800

    PubMed  CAS  Google Scholar 

  55. Robinson AHN, Ayllon-Garcia A, Hallet JP, Meggitt BF (1995) Periprosthetic fractures on the hip: the Mennen clasp plate. Hip Int 5:20–24

    Google Scholar 

  56. Roffman M, Mendes DG (1989) Fracture of the femur after total hip arthroplasty. Orthopedics 12:1067–1070

    PubMed  CAS  Google Scholar 

  57. Schmidt AH, Kyle RF (2002) Periprosthetic fractures of the femur. Orthop Clin North Am 33:143–152

    Article  PubMed  Google Scholar 

  58. Schutz M, Müller M, Krettek C, Hontzsch D, Regazzoni P, Ganz R, Haas N (2001) Minimally invasive fracture stabilization of distal femoral fractures with the LISS: a prospective multicenter study. Results of a clinical study with special emphasis on difficult cases. Injury 32 [Suppl 3]:SC48–SC54

    PubMed  Google Scholar 

  59. Scott RD, Turner RH, Leitzes SM (1975) Femoral fractures in conjunction with total hip replacement. J Bone Joint Surg 57A:494–501

    PubMed  CAS  Google Scholar 

  60. Serocki JH, Chandler RW, Dorr LD (1992) Treatment of fractures about hip prostheses with compression plating. J Arthroplasty 7:129–135

    Article  PubMed  CAS  Google Scholar 

  61. Siegmeth A, Ment-Chiari WA, Wozasek GE, Vècsei V (1998) Femur fractures in patients with hip arthroplasty: Indications for revision arthroplasty. J South Orthop Assoc 7:251–258

    PubMed  CAS  Google Scholar 

  62. Sledge JB III, Abiri A (2002) An algorithm for the treatment of Vancouver type A2 periprosthetic proximal femoral fractures. J Arthroplasty 17:887–892

    Article  PubMed  Google Scholar 

  63. Springfield DS (1987) Massive autogenous bone grafts. Orthop Clin North Am 18:249–256

    PubMed  CAS  Google Scholar 

  64. Stern RE, Harwin SF, Kulick RG (1991) Management of ipsilateral femoral shaft fractures following hip arthroplasty. Orthop Rev 20:779–784

    PubMed  CAS  Google Scholar 

  65. Tadross TSF, Nanu AM, Buchanan MJ, Checketts RG (2000) Dall–Miles plating for periprosthetic B1 fractures of the femur. J Arthroplasty 15:49–51

    Article  Google Scholar 

  66. Tower SS, Beals RK (1999) Fractures of the femur after hip replacement. The Oregon experience. Orthop Clin North Am 30:235–247

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  68. Tsiridis E, Haddad FS, Gie GA (2003) Dall–Miles plates for periprosthetic femoral fractures. A critical review of 16 cases. Injury 34:107–110

    Article  Google Scholar 

  69. Uchio Y, Shu N, Nishikawa U, Takata N, Ochi M (1997) Mennen plate fixation for fractures of the femoral shaft after ipsilateral hip arthroplasty. J Trauma 42:1157–1161

    PubMed  CAS  Google Scholar 

  70. Venu KM, Koba R, Garikipati R, Shenava Y, Madhu TS (2001) Dall–Miles cable and plate fixation for the treatment of periprosthetic femoral fractures—analysis of the results in 13 cases. Injury 32:395–400

    Article  PubMed  CAS  Google Scholar 

  71. Wagner M, Knorr-Held F, Hohmann D (1996) Measuring stability of wire cerclage in femoral fractures when performing total hip replacement. In vitro study on a standardized bone model. Arch Orthop Trauma Surg 115:33–37

    Article  PubMed  CAS  Google Scholar 

  72. Wahl B, Grasshoff H, Meinecke I, Neumann HW (2001) Results of operative treatment of periprosthetic femoral shaft fracture after total hip arthroplasty. Zentralbl Chir 126:50–54

    Article  PubMed  CAS  Google Scholar 

  73. Wang G-J, Miller TO, Stamp WG (1985) Femoral fracture following hip arthroplasty. J Bone Joint Surg 67A:956–958

    PubMed  CAS  Google Scholar 

  74. Wang J-W, Wang C-J (2000) Periprosthetic fracture of the femur after hip arthroplasty: the clinical outcome using cortical strut allografts. J Orthop Surg 8:27–31

    CAS  Google Scholar 

  75. Watanabe Y, Shiba N, Matsuao S, Higuchi F, Tagawa Y, Inoue A (2000) Biomechanical study of the resurfacing hip arthroplasty: finite element analysis of the femoral component. J Arthroplasty 15:505–511

    Article  PubMed  CAS  Google Scholar 

  76. Whittaker RP, Sotos LN, Ralston EL (1974) Fractures of the femur about femoral endoprostheses. J Trauma 14:675–694

    Article  PubMed  CAS  Google Scholar 

  77. Wilson D, Masri BA, Duncan CP (2001) Periprosthetic fractures: an operative algorithm. Orthopedics 24:869–870

    PubMed  CAS  Google Scholar 

  78. Wong P, Gross AE (1999) The use of structural allografts for treating periprosthetic fractures about the hip and knee. Orthop Clin North Am 30:259–264

    Article  PubMed  CAS  Google Scholar 

  79. Zenni EJ Jr, Pomeroy DL, Caudle RJ (1988) Ogden plate and other fixations for fractures complicating femoral endoprostheses. Clin Orthop 231:83–90

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Clinic of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic of Markgröningen, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Germany

    Bernd Fink & Joachim Singer

  2. Orthopaedic Department, Clinic for Rheumatology, University of Hamburg, Bad Bramstedt, Germany

    Martin Fuerst

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  1. Bernd Fink
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Correspondence to Bernd Fink.

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Fink, B., Fuerst, M. & Singer, J. Periprosthetic fractures of the femur associated with hip arthroplasty. Arch Orthop Trauma Surg 125, 433–442 (2005). https://doi.org/10.1007/s00402-005-0828-0

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