Periprosthetic Insufficiency Fracture around Radiographically Loose Cemented Stem: A Report of Two Cases

Abstract

As the osteoporotic patient population grows, various periprosthetic fractures that cannot be classified appropriately can occur around the femur after hip arthroplasty. We experienced two cases of periprosthetic insufficiency fractures at subtrochanteric area of the femurs around radiographically loose cemented femoral stems. The ages of the patients were 75 years and 83 years. Both patients could not recall any history of trauma before the onset of pain. Both were treated non-operatively. Both healed uneventfully and did not recur after two years of follow up. When the osteoporotic patient with cemented stem showed sudden hip or thigh pain without a history of trauma, great attention should be focused to find this lesion.

Prognostic Factors and Clinical Outcomes after Treatment of Periprosthetic Femoral Fractures Using a Cable-plate

“…In principle, the plate should be of sufficient length for firm fixation because a longer plate with empty screw holes at the fracture site provides a longer working length than a short plate. Previous reports recommend that the plate used for internal fixation must be of sufficient length to allow as much overlap of the femoral stem as possible1222). A longer plate ending near the end of the bone is preferable to the one ending in the metadiaphyseal zone.…”

“…An analysis of prognostic factors relating to the treatment of PFF using cable-plates was lacking. The treatment of PFFs requires particular care because stable fixation is difficult in this situation as compared to ordinary fractures; significant effort has been spent to properly classify and treat PFFs1112). The purpose of this study was to assess clinical outcomes and analyze potential prognostic factors in the treatment of PFFs using the cable-plate construct.…”

Periprosthetic stress fracture around a well-fixed type 2B short uncemented stem

“…We found only 3 reports of stress fractures occurring around femoral stems [ 6 – 8 ]. Chun et al reported 2 cases of insufficiency fractures located at the subtrochanteric area of loose, cemented stems [ 6 ].…”

“…We found only 3 reports of stress fractures occurring around femoral stems [ 6 – 8 ]. Chun et al reported 2 cases of insufficiency fractures located at the subtrochanteric area of loose, cemented stems [ 6 ]. The authors alleged that osteoporotic bones of elderly patients might produce atraumatic, atypical femoral fractures different to that of the ones reported with bisphosphonate therapy.…”

“…Atraumatic periprosthetic stress fractures constitute an extremely unusual cause of femoral pain. Only a few reports have addressed this issue, especially around loose, cemented stems or modular ones [ 6 – 8 ]. To our knowledge, no cases of stress fractures had been reported around short stems in otherwise healthy patients.…”