Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Periprosthetic Fracture of the Femur after Total Hip Arthroplasty. Treatment and Results to Date*†

Abstract

Postoperative periprosthetic femoral fractures have become increasingly common during the last decade. A wide range of problems, such as comminution and bone loss, are seen in association with these fractures, and the additional challenge of a loose femoral component is commonly encountered. When a femoral fracture occurs in a patient in whom the femoral component is in place, reconstruction may be reasonably straightforward or it may be nearly impossible. Options for treatment have included the use of traction, casts, and external braces; operative reduction with internal fixation; numerous revision procedures involving insertion of a long-stem femoral component for stabilization of the fracture; and bone-grafting with use of either autogenous grafts or allografts1-3,5-12,19-24,35,36,38-42,45,49-51,55,56. These fractures must be treated according to their individual characteristics, the status of the implant, associated medical conditions, and the patient's level of physical activity2,11,23,35. Knowledge of the results in previously reported series and information regarding the range of treatment options can facilitate optimum decision-making with regard to these injuries. The number of patients who are seen with a postoperative periprosthetic fracture of the femur has increased steadily at our institution during the last twenty-five years (Fig. 1). Between 1989 and 1993, fracture was the second leading cause of revision hip arthroplasty at the Mayo Clinic, ranking after loosening of the implant and before dislocation and infection (Fig. 2). Reports have suggested an over-all prevalence of between 0.1 and 1.1 per cent, with ten postoperative periprosthetic fractures (0.2 per cent) found in 5400 patients in one of the largest series. However, these estimates apply to patients who had a femoral …