Abstract
The incidence of periprosthetic fractures has rapidly increased in the last two decades and has been the cause of a large number of revision surgeries and permanent physical disability for many patients, as well as a significant socioeconomic burden for many nations. This research deals with a periprosthetic femur fracture real event, occurred following a total hip arthroplasty and treated with one of the most widespread internal fixation methods: the implant of a periprosthetic femur plate system. A Finite Element analysis was performed to investigate the implanted femur plate break after a short follow-up and to understand the plate break causes. Such events are currently object of forensic debate as more and more often hospitals, surgeons, and medical device manufacturers are denounced by patients to whom similar events occur. In this work, different load situations acting on the femur during daily and incidental activities were simulated, in order to validate the correct behavior of the plate, according to the intended use recommended by the manufacturer. The analysis demonstrates that the plate failure can occur in situations of unconventional loading such as that caused by stumbling and in presence of incomplete bone healing.
Highlights
Periprosthetic fractures (PF) are bone accidents associated with an orthopedic implant, whether a replacement device or an internal fixation device
This study aims to quantitatively analyse, by means of a Finite Element (FE) analysis, the possible causes of a real case of femoral plate break, implanted following a periprosthetic femoral fractures (PFF)
In this work a FE model reproducing a femur plate implant after a PFF event was implemented in order to investigate the actual load condition that may have led to the break of the femur plate
Summary
Periprosthetic fractures (PF) are bone accidents associated with an orthopedic implant, whether a replacement device or an internal fixation device. The most common post-operative PF localization is the femur, with a higher incidence associated with total hip arthroplasty (THA) with respect those related to total knee arthroplasty (TKA) (Schwarzkopf et al, 2013; Capone et al, 2017). The periprosthetic femoral fractures (PFF) can range from minor injuries, with a minimal effect on the patient’s outcome, to being catastrophic and drastically reduce the patient’s quality of life. The increase of the PF related to THA during the last two decades, has been a worldwide considerable economic burden for the national economies. The PFF can be classified into intraoperative or post-operative: intraoperative PFF occurs during the surgical procedure, while post-operative PFF occurs averagely in the first decade from the intervention and is more frequent in patients with prior
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