We evaluated the treatment and outcome of 47 cases of periprosthetic femoral fracture presenting to our unit over a nine-year period. The average follow-up period was 48 months (range 24-114). Surgical treatment involved stem revision in 29 hips, open reduction and internal fixation in 11 hips and conservative treatment in seven hips. The mean HHS at the most recent follow-up was 74 (range 49-91). Twenty-five patients were pain-free (53%), 10 patients had occasional mild pain (21%), eight patients had a limp and pain (17%) and four patients had severe disability (9%). Postoperative radiographs showed complete fracture union in all 47 patients. There were 11 complications: three further periprosthetic fractures, two aseptic loosenings, two dislocations, two aseptic loosenings of the primary prostheses, one stem breakeage, and one intraoperative fracture. Our results suggest cementless revision with tapered fluted stems used without cortical strut grafts are a valid procedure for the treatment of Vancouver B2 and B3 periprosthetic fractures.
LewallenD.G., BerryD.J.Periprosthetic fracture of the femur after total hip arthroplasty: treatment and result to date. Instr Course Lect.1998; 47: 243–9.
2.
BerryD.J.Epidemiology: hip and knee. Orthop Clin North Am.1999; 30(2): 183–90.
3.
KavanaghB F.Femoral fractures associated with total hip ar-throplasty. Orthop Clin North Am.1992; 23: 249–57.
4.
FranklinJ., MalchauH.Risk factors for periprosthetic femoral fracture. Injury.2007; 38: 655–60.
5.
LindahlH., GarellickG., RegnerH., HerbertsP., MalchauH.Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am.2006; 88: 1215–22.
6.
DuncanC P., MasriB.A.Fractures of the femur after hip replacement. In: Jackson DW, Ed. Instructional Course Lectures 44. Rosemont (III) American Academy of Orthopaedic Surgeons.1995; 293–300.
7.
BealsR.K., TowerS.S.Periprosthetic fractures of the femur: an analysis of 93 fractures. Clin Orthop Relat Res.1996; (327): 238–44.
8.
MontM.A., MaarD.C.Fractures of the ipsilateral femur after hip arthroplasty. A statistical analysis of outcome based on 487 patients. J Arthroplasty.1994; 9(5): 511–6.
9.
DysartS.H., SavoryC.G., CallaghanJ.J.Non-operative treatment of a post-operative fracture around an uncemented porous-coated femoral component. J Arthroplasty.1989; 4(2): 187–92.
10.
KellyS.S.Periprosthetic femoral fractures. J Am Acad Orthop Surg.1994; 2(3): 164–9.
11.
JohanssonJ.E., McBroomR., BarringtonT.W., HunterG.A.Fracture of the ipsilateral femur in patients with total hip replacement. J Bone Joint Surg Am.1981; 63(9): 1435–42.
12.
SchwartzJ.T.Jr., MayerJ.G., EnghC.A.Femoral fracture during non-cemented total hip arthroplasty. J Bone Joint Surg Am.1989; 71(8): 1135–42.
13.
CookeP.H., NewmanJ.H.Fractures of the femur in relation to cemented hip prostheses. J Bone Joint Surg Br.1988; 70(3): 386–9.
14.
BradyO.H., GarbuzD.S., MasriB.A., DuncanC.P.The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty.2000 Jan; 15(1): 59–62.
15.
ParkM.S., LimY.J., ChungW.C., HamD.H., LeeS.H.Management of periprosthetic femur fractures treated with distal fixation using a modular femoral stem using an anterolateral approach. J Arthroplasty2009; 8(9): 1270–6.
16.
EnghC.A., BobynJ.D., GlassmanA.H.Porous-coated hip re placement. The factors governing bone ingrowth, stress shielding and clinical results. J Bone Joint Surg Br.1987; 69(1): 45–55.
17.
HerrlinK., PetterssonH., SelvikG.Comparison of two- and three-dimensional methods for assessment of orientation of the total hip prosthesis. Acta Radiol.1988; 29(3): 357–62.
ChakravarthyJ., BansalR., CooperJ.Locking plate os-teosynthesis for Vancouver type B1 and type C peripros-thetic fractures of femur: a report on 12 patients. Injury2007; 38(6): 725–733.
20.
LindahlH., OdenA., GarellickG., MalchauH.The excess mortality due to periprosthetic femur fracture. A study from the Swedish national hip arthroplasty register. Bone2007; 40(5): 1294–1298.
21.
AgarwalS., AndrewsC.M., BakeerG.M.Outcome following stabilization of type B1 periprosthetic femoral fractures. J Arthroplasty.2005; 20(1): 118–21.
22.
MacDonaldS.J., PaproskyW.G., JablonskyW.S., MagnusR.G.Periprosthetic femoral fractures treated with a long-stem cementless component. J Arthroplasty.2001; 16(3): 379–83.
23.
SpringerB.D., BerryD.J., LewallenD.G.Treatment of peri-prosthetic femoral fractures following total hip arthroplasty with femoral component revision. J Bone Joint Surg Am.2003; 85(11): 2156–62.
24.
NeumannD., ThalerC., DornU.Management of Vancouver B2 and B3 femoral periprosthetic fractures using a modular cementless stem without allografting. Int Orthop2011; 36(5): 1045–50.
25.
FinkB., GrossmannA., SingerJ.Hip revision arthroplasty in periprosthetic fractures of Vancouver type B2 and B3. J Orthop Trauma.2012; 26(4): 206–11.
26.
MukundanC., RayanF., MacdonaldD.Management of late periprosthetic femur fractures: a retrospective cohort of 72 patients. Int Orthop.2010; 34(4): 485–9.
27.
BerryD.J.Treatment of Vancouver B3 periprosthetic femur fractures with fluted tapered stem. Clin Orthop Relat Res.2003; (417): 224–31.
28.
O'SheaK., QuinlanJ F., KuttyS., MulcahyD., BradyO.H.The use of uncemented extensively porous-coated femoral components in the management of Vancouver B2 and B3 periprosthetic femoral fractures. J Bone Joint Surg Br.2005; 87(12): 1617–21.
29.
ZuurmondR.G., Van WijheW., Van RaayJ.J., BulstraS.K.High incidence of complications and poor clinical out come in the operative treatment of periprosthetic femoral fractures: An analysis of 71 cases. Injury.2010; 41(6): 629–33.
30.
ParkS.K., KimY.G., KimS.Y.Treatment of periprosthetic femoral fractures in hip arthroplasty. Clin Orthop Surg.2011; 3(2): 101–6.
31.
ChandlerH P., KingD., LimbirdR.The use of cortical allograft Struts for fixation of fractures associated with well-fixed total joint prostheses. Semin Arthroplasty.1993; 4(2): 99–107.
32.
RicciW.M., BolhofnerB.R., LoftusT.Indirect reduction and plate fixation without grafting for periprosthetic femoral shaft fractures about a stable intramedullary implant. J Bone Joint Surg Am.2005; 87(10): 2240–5.
33.
ChandlerH P., TiggersR.G.The role of allografts in the treatment of periprosthetic femoral fractures. Instr Course Lect.1998; 47: 257–264.
