Periprosthetic fractures

Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.

1. 1 Evaluation results of surgical treatment of periprosthetic femoral fractures of THA in years 2004-2010 Martin Korbel Ortopedická klinika FN Hradec Králové

2. Incidence 0,4 – 6 % increase in revision surgeries obese patiens (BMI over 35) elderly patients with fragile bones in cementless total hip arthoplasties

3. Vancouver classification - location of the fracture - fixation of the stem - quality of the remaining bone stock

4. Vancouver A fractures involve the greater or lesser trochanter stable conservative treatment ( protected weight bearing ) unstable trochanteric cerclage

5. Vancouver B around or just distal to stem surgical treatment B1 – the stem remains well fixed open reduction and internal fixation B2 – the stem is loose long stem revision, cerclage B3 – the stem is loose and the proximal femur is deficient long stem revision , cerclage

6. Vancouver C below the stem with no stem loosening open reduction and internal fixation leaving the stem

7. Methodics periprosthetic fractures 47 patients 40, men 18, women 22 2004 5 2005 7 2006 4 2007 7 2008 9 2009 8 2010 7

8. Methodics average time from total hip arthroplasty 7 years and 3 months Vancouver A 2 Vancouver B1 3 Vancouver B2 27 Vancouver B3 7 Vancouver C 8 cemented prosthesis 20 cementless prosthesis 23 hybrid prosthesis 4 intraoperative fractures 3

9. Comorbidity 4 condition after stroke 3 Parkinson´s disease 2 Bechterew ´s disease 3 condition after peripheral nerve paresis 1 alcoholism

10. 10 * 11 years after implantation ------------------------ * walking the walking stick * no pain * F 90 * A 30 * IR 10 * ER 20

11. 11 * 4 years after implantation ---------------------- * walk without support * no pain * F 90 * A 30 * IR 10 * ER 20

12. 12 * 2 months after implantation ------------------------------ * complicated by pulmonary embolism * walk without support * no pain * F 110 * A 40 * IR 10 * ER 30

13. 13 * conditoin after stroke with right - sided hemiparesis * 7 years after implantation * complicated by hemorrhagic shock * walking in walker * no pain * F 80 * A 25 * IR 10 * ER 10

14. 14 * 12 years after implantation ------------------------ * walking without support * no pain * F 90 * A 20 * IR 10 * ER 10

15. 15 * 2 years after implantation ----------------------- * walking the walking stick * no pain * F 90 * A 30 * VR 10 * ZR 10

16. Vancouver A (2) 16 2 trochanteric cerclage Treatment results no pain 2 walking the walking stick F 100, A 30, IR 10, ER 15 no complication

17. 17 Vancouver B1 (3) 3 open reduction and internal fixation Treatment results 1 walking without support 2 walking the walking stick F 80, A 25, IR 5, ER 10 1 fracture plate osteosynthesis , 1 superficial infection

18. 18 Vancouver B2 (27) 17 long stem revision + cerclage 9 open reduction and internal fixation (4 long fracture excess revision stem length , 3 condition after long stem revision ) 1 extension ( sepsis ) Treatment results 2 persistent mild pain 5 walking without support 18 walking the walking stick 5 walking in walker F 74, A 25, IR 10, ER 12 4 fracture plate osteosynthesis , 1 fracture of the femoral stem, 2 luxation , 3 femoral nerve palsy , 2 deep infection , 2 hemorrhagic shock , 1 stroke , 1 pulmonary embolism

19. 19 Vancouver B3 (7) 2 long stem revision + cerclage 3 tumor stem revision 2 extension Treatment results no pain 1 walking without support 4 walking the walking stick 2 walking in walker F 75, A 20, IR 10, ER 12 1 superficial infection

20. 20 Vancouver C (8) 7 open reduction and internal fixation Treatment results 1 persistent mild pain 3 walking without support 2 walking the walking stick 2 walking in walker F 88, A 30, IR 15, ER 15 no complication

21. 21 Conclusion large number of patients with diseases of the nervous or musculoskeletal system generally poor results with a large number of complications in the group of Vancouver B2 fractures Vancouver B2 fractures treated with the implantation of the revision stems and cerclage