Periprosthetic Femur Fractures

Abstract

Successful treatment of periprosthetic femur fractures, like all fractures, requires careful attention to understand the fracture pattern nuances, identifying and executing a rational treatment approach, and providing an appropriate postoperative recovery protocol. Unlike most other fractures, modification of standard techniques is often required to obtain a stable fixation construct, and there is a greater role for revision arthroplasty in the treatment of periprosthetic fractures. Optimal indications for surgical repair versus revision arthroplasty and optimal postoperative weight-bearing protocols remain uncertain. Reported outcomes for patients with periprosthetic femoral shaft fractures are generally good and are relatively consistent. Results for periprosthetic distal femur fractures, however, are less good and more inconsistent. Both periprosthetic femoral shaft and distal femur fractures are associated with relatively high mortality rates, approaching that of patients with hip fractures. This review should provide insight into the current solutions and challenges for the treatment of patients with periprosthetic femur fractures.

Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty

“…[6,10,20,21] According to our study, the operation time and amount of bleeding of patients with intraoperative PFF in primary THA were all significantly greater than those of controls, and the financial cost for the treatment of PFF was also considerably higher, especially for those using plate or cortical allograft strut during revision. Besides, PFF posed great challenges to orthopedic surgeons because of its common associations with poor follow-up outcomes and high mortality rate.…”

“…[20] The most commonly used treatment strategy was fixation with cerclage wire or band for intraoperative PFF, followed by revision with a long stem implant. As to the postoperative PFF, the main treatment was long stem revision with plate or cortical allograft strut fixation (Table 4).…”

“…As the proximal part of S-ROM prosthesis is tapered in shape, the fracture generally occurs in the process of reaming of the medullary canal and inserting of the prosthesis stem. The treatment of PFF in our study was dependent on the Vancouver classification system, patient's characteristics, and experience of surgeon, [20] this type of PFF can be treated by fixation with cerclage wire or band.…”

“…Most of postoperative PFFs were type B, the treatment of which should take into consideration fracture pattern, stability, and bone stock, whereas for type C, surgical fixation strategy should be decided according to principles of trauma. [20] …”

Revision Arthroplasty Using a MUTARS® Prosthesis in Comminuted Periprosthetic Fracture of the Distal Femur

“…Periprosthetic fractures after total knee arthroplasty (TKA) are also gradually increasing 12345. Of the patients who undergo primary TKA, 0.3–2.5% are reported to sustain a periprosthetic fracture as a catastrophic complication of primary TKA 12346…”