Inquadramento clinico diagnostico delle fratture periprotesiche

Abstract

This paper critically reviews the literature on epidemiology, risk factors, clinical evaluation and diagnostic assessment of both femoral and acetabular periprosthetic fractures (PPF). Evaluation of both National Registries and the literature shows an increase in PPF rates throughout the years. The exact rate of PPF cases appears to be underestimated, especially as regards intraoperative and acetabular PPF. There are multiple risk factors for PPF, both patient-related and implant-related. In detail, bone mechanical resistance impairment and conditions of poor alignment, loosening and implant design should all be carefully considered. A thorough radiographic assessment together with evaluation of radiographic history of the implant are paramount to diagnose the fracture condition and possible loosening. CT scans are useful for diagnosing PFF in case of negative X-rays, especially on the acetabular side. The classification systems described in the literature proved to be reliable and reproducible, especially for the femur. Hip PPFs are a growing problem because of the increase in total hip arthroplasty implants and because of population ageing. Clinical evaluation and diagnostic assessment are of primary importance in the management of these fractures. The diagnosis needs to be properly addressed by clinical suspicion, with the use of second-level exams in selected cases.