Abstract
SummaryBackgroundPeriprosthetic fractures (PPF) of the femur remain challenging, especially in patients with previous multiple revisions. Modular megaprostheses (mMPs) are rarely used in this indication; however, in some cases mMPs seem to be the last chance for limb salvage. We aimed to evaluate the clinical outcome of PPFs of the femur treated by modular mMPs at our institution.Patients and methodsIn this study 33 patients (27 female; mean age 79 years) with a PPF after total hip or total knee arthroplasty (no tumor indications) were treated using modular proximal (mPFR; n = 12), distal (mDFR; n = 14) or total (mTFR; n = 7) femur replacement. A retrospective evaluation regarding mortality and revision rates was performed. Failures with need for revision were classified.ResultsAt a mean follow up of 60 months (range 0–178 months), the total mortality rate as well as total revision rate were both found to be 39%. At 1 year follow-up the mortality rate was highest within the mDFR group, and less revisions were necessary in the mPFR group, however both findings were not significantly. Those patients, who had revision surgery before PPF, were found to have higher revision rate after implantation of mMP. In the mPFR group, dislocation was the most frequent failure, within the mDFR and the mTFR group infection. In one case amputation of the lower limb was necessary.ConclusionmMPs represent a valuable option in PPFs of the femur. Infection and dislocation remain the most frequent complications. Prospective clinical studies are required to further define the outcome of mMPs in PPFs of the femur.
Highlights
Periprosthetic fractures (PPFs) of the femur are relatively rare events
Similar findings are described around the knee joint with 0.3–2.5% after primary total knee arthroplasty (TKA) and 1.6–38%
After revision TKA [2]; the continuing increase in the frequency of total hip arthroplasty (THA) and TKA will result in a higher number of PPFs in the future [3, 4]
Summary
Periprosthetic fractures (PPFs) of the femur are relatively rare events. The incidence after primary total hip arthroplasty (THA) is described as 0.1–1% and up to 20% after revision THA [1]. Similar findings are described around the knee joint with 0.3–2.5% after primary total knee arthroplasty (TKA) and 1.6–38%. A critical evaluation of potential treatment options for PPFs of the femur has to be made. While numerous studies deal with the surgical treatment of PPFs using open reduction and internal fixation with conventional non-locked plating, locked plating and retrograde intramedullary nailing, the reports of the use of modular megaprostheses (mMP) for endoprosthetic proximal (mPFR), distal (mDFR) or total femoral replacement (mTFR) are meager [5,6,7].
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