Periprosthetic fractures

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Evaluation results of surgical treatment of periprosthetic femoral fractures of THA in years 2004-2010

Martin KorbelOrtopedická klinika FN Hradec Králové

Incidence 0,4 – 6 %

increase in revision surgeries obese patiens (BMI over 35) elderly patients with fragile bones in cementless total hip arthoplasties

Vancouver classification

- location of the fracture- fixation of the stem- quality of the remaining bone stock

Vancouver A

fractures involve the greater or lesser trochanter

stable conservative treatment (protected weight bearing)

unstable trochanteric cerclage

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

deficientlong stem revision, cerclage

Vancouver C

below the stem with no stem loosening

open reduction and internal fixation leaving the stem

Methodics

periprosthetic fractures 47patients 40, men 18, women 22

2004

5

2005

7

2006

4

2007

7

2008

9

2009

8

2010

7

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2004 2005 2006 2007 2008 2009 2010

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

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

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

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* 4 years after implantation

----------------------* walk without support * no pain* F 90* A 30* IR 10* ER 20

12

* 2 months after implantation------------------------------* complicated by pulmonary

embolism * walk without support * no pain* F 110* A 40* IR 10* ER 30

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

* 12 years after implantation

------------------------* walking without support* no pain* F 90* A 20* IR 10* ER 10

15

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

Vancouver A (2)

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2 trochanteric cerclage

Treatment results no pain 2 walking the walking stick F 100, A 30, IR 10, ER 15 no complication

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

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

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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

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

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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