An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component

Corten, Kristoff; Vanrykel, F; Bellemans, Johan; Frederix, P. Reynders; Simon, Jean‐Pierre; Broos, Paul

doi:10.1302/0301-620x.91b11.22292

Cited by 121 publications

(93 citation statements)

References 38 publications

(72 reference statements)

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“…No other stems have been revised. The series of Corten et al [3] included 36 B 1 fractures. A lateral plate was used in 33 hips; in the three in which the medial comminution [14]; ORIF = open reduction and internal fixation; NA = not applicable.…”

Section: Discussionmentioning

confidence: 99%

Periprosthetic Fractures Around a Cementless Hydroxyapatite-coated Implant: A New Fracture Pattern Is Described

Capello

DʼAntonio

Naughton

2013

Clin Orthop Relat Res

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Background Periprosthetic fractures can occur both intraoperatively and postoperatively with implantation of cementless tapered stems. Questions/purposes In a large cohort of patients receiving cementless, proximally hydroxyapatite-coated femoral implants, we answered the following questions: What was the incidence of intraoperative and postoperative fractures associated with the implant? What were the fracture patterns as classified by the Vancouver classification system? Did the Vancouver classification represent the fracture patterns found? How were the fractures treated and what were the treatment outcomes; that is, how many fractures healed and did the stems osseointegrate? Methods We evaluated 1039 hips (932 patients) from three prospective studies. The hips were divided into three groups: no fractures, intraoperative fractures, and postoperative fractures. Demographic differences among the groups were noted. Postoperative fractures were classified using the Vancouver classification system. We judged stem stability using Engh's criteria and fracture union was determined by the treating surgeon and confirmed by the authors. Results We identified 58 periprosthetic fractures in the 1039 hips (5.6%): 38 intraoperative (3.7%) and 20 postoperative (1.9%). Eleven of the postoperative fractures were classifiable by the original Vancouver classification system and nine were of the newly described ''clamshell'' variety, not classifiable by this system. No intraoperative fractures extended below the lesser trochanter. Twenty-five of these fractures were treated with a single cable or cerclage wire. The remaining received no specific treatment. Of the 20 postoperative fractures, five were treated nonoperatively. All stems osseointegrated. Conclusions Both intraoperative and postoperative fractures can be managed with success when the stem is

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Section: Discussionmentioning

confidence: 99%

Periprosthetic Fractures Around a Cementless Hydroxyapatite-coated Implant: A New Fracture Pattern Is Described

Capello

DʼAntonio

Naughton

2013

Clin Orthop Relat Res

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“…An in-depth exploration and comparison of fracture management is beyond the scope of this classification summary, however, numerous studies evaluating various surgical interventions are worth mentioning [1,5,6,8,11,12,15,20].…”

Section: Discussionmentioning

confidence: 99%

“…Authors have reported good results after treatment of Type B1 fractures with lateral plates without bone grafting [1,5,20], whereas others advocate the routine use of cortical strut allografts with or without plates [6,12], especially in the presence of medial cortex comminution [8]. Biomechanical analyses investigating optimal construct stiffness have led to varying recommendations of ideal constructs including: nonlocking cable plate and allograft [23], allograft-plate [22], and plate with proximal unicortical screws with or without cables and distal bicortical screws [9].…”

Section: Discussionmentioning

confidence: 99%

“…The trend is toward indirect reduction methods with use of percutaneous plating for truly stable implants, but never at the expense of obtaining an anatomic fracture reduction. Augmentation with cortical strut allografts has a role in select cases to enhance healing from biologic and mechanical standpoints in periprosthetic fractures [6,8,12,22,23].…”

Section: Discussionmentioning

confidence: 99%

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In Brief: Classifications in Brief: Vancouver Classification of Postoperative Periprosthetic Femur Fractures

Gaski

Scully

2011

Clinical Orthopaedics &Amp; Related Research

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“…Although the risk for periprosthetic fracture is increased by numerous specific factors such as increased age, cortical bone loss, and infection, the most frequent cause is loosening of the femoral prosthesis, which is noted on approximately 80% of all pre -fracture radiographs (1,2).…”

Section: Introductionmentioning

confidence: 99%

Successful Outcomes Using Interlocking Prostheses for Periprosthetic Fractures with Loose Femoral Components

et al. 2015

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INTRODUCTIONPeriprosthetic femoral fracture is a serious complication of hip arthroplasty that is challenging to treat, particularly when accompanied by implant loosening. Although the risk for periprosthetic fracture is increased by numerous specific factors such as increased age, cortical bone loss, and infection, the most frequent cause is loosening of the femoral prosthesis, which is noted on approximately 80% of all pre -fracture radiographs (1, 2).The Vancouver classification developed by Duncan and Masri is the most common guide for surgeons during preoperative planning (3). The stability of the femoral component on the proximal fragment is the basic criterion for this classification, with the B2 and B3 types defined as a periprosthetic fracture around the implant with a loose prosthesis and adequate (B2) or compromised (B3) bone stock. These two fracture types are very complicated to treat, and management remains controversial. Among the surgical options available are open reduction and internal fixation, revision arthroplasty using cemented or cementless long stems, and total femur arthroplasty with megaprosthesis.We report here 4 cases with a Vancouver type B2 or B3 periprosthetic femoral fracture treated by revision arthroplasty using a cementless long stem with an interlocking system. CASE PRESENTATIONS Case 1An 86-year-old man who had undergone bipolar hemiarthroplasty for a right femoral neck fracture at a local hospital 7 years earlier fell while cycling and fractured his right femur. Radiographs showed a periprosthetic femoral fracture at the tip of the stem. Although the proximal bone stock was maintained, clear lines hole around the stem and stem subsidence were observed ; therefore, a Vancouver type B2 fracture was diagnosed (Fig. 1A).Revision bipolar hemiarthroplasty was performed using a longstem cementless implant with interlocking screws. To augment bone stock, a cancellous allograft was applied to the fracture site and proximal bone defect. After the operation, he had rehabilitation, range of motion and gait training. He was allowed to walk with full weight bearing. At final examination 18 months after surgery, radiographs showed bony union of the fracture and no evidence of stress shielding (Fig. 1B, C)

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An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component

Cited by 121 publications

References 38 publications

Periprosthetic Fractures Around a Cementless Hydroxyapatite-coated Implant: A New Fracture Pattern Is Described

Periprosthetic Fractures Around a Cementless Hydroxyapatite-coated Implant: A New Fracture Pattern Is Described

In Brief: Classifications in Brief: Vancouver Classification of Postoperative Periprosthetic Femur Fractures

Successful Outcomes Using Interlocking Prostheses for Periprosthetic Fractures with Loose Femoral Components

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