Management of periprosthetic femoral fractures following total hip replacement; A Case Series

Abstract

Background: Periprosthetic femoral fractures following total hip arthroplasty (THA) are not very uncommon. At present the Vancouver classification provides management algorithm for deciding treatment options but treatment options may vary between surgeons, where as in this study most patients managed were according to Vancouver classification management algorithm. The most common treatment modality for treating periprosthetic femoral fractures around a well-fixed stem is with osteosynthesis, but fracture with loose stem requires revision arthroplasty and fracture with poor bone requires bone graft augmentation. Methods: We reviewed 21 consecutive cases with periprosthetic femoral fractures in association with THA between June 2018 and December 2020. Locking and non locking compression plates, wires, cables system were used for osteosynthesis. Most of fractures were managed according to Vancouver classification management algorithm but modified in some cases according to the surgeon’s skills and judgment. Results: According to Vancouver classification, two patients had AL fractures, two patients had AG fractures, twelve Patients had B1, five patients had B2, two patients had B3 and one patient had type C fracture. Of these two cases were treated by conservatively, sixteen cases were treated by osteosynthesis, three cases by revision arthroplasty. Conclusion: The careful analysis of implant stability and fracture patterns is crucial for the optimal treatment of Periprosthetic femoral fractures. Expert Surgeon’s skills are needed to deal with periprosthetic femoral fractures.