Periprosthetic fracture fixation of the femur following total hip arthroplasty: A review of biomechanical testing – Part II

Katherine Wang,Eustathios Kenanidis,Mark Miodownik,Eleftherios Tsiridis,Mehran Moazen

doi:10.1016/j.clinbiomech.2018.12.001

Katherine Wang, Eustathios Kenanidis + Show 3 more

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https://doi.org/10.1016/j.clinbiomech.2018.12.001

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Abstract

BackgroundPeriprosthetic femoral fracture is a severe complication of total hip arthroplasty. A previous review published in 2011 summarised the biomechanical studies regarding periprosthetic femoral fracture and its fixation techniques. Since then, there have been several commercially available fracture plates designed specifically for the treatment of these fractures. However, several clinical studies still report failure of fixation treatments used for these fractures. MethodsThe current literature on biomechanical models of periprosthetic femoral fracture fixation since 2010 to present is reviewed. The methodologies involved in the experimental and computational studies of periprosthetic femoral fracture fixation are described and compared with particular focus on the recent developments. FindingsSeveral issues raised in the previous review paper have been addressed by current studies; such as validating computational results with experimental data. Current experimental studies are more sophisticated in design. Computational studies have been useful in studying fixation methods or conditions (such as bone healing) that are difficult to study in vivo or in vitro. However, a few issues still remain and are highlighted. InterpretationThe increased use of computational studies in investigating periprosthetic femoral fracture fixation techniques has proven valuable. Existing protocols for testing periprosthetic femoral fracture fixation need to be standardised in order to make more direct and conclusive comparisons between studies. A consensus on the ‘optimum’ treatment method for periprosthetic femoral fracture fixation needs to be achieved.

Highlights

Periprosthetic femoral fractures (PFF) is a severe complication following total hip arthroplasty (THA); the rate of intraoperative PFF ranged from 0.1–27.8% and of postoperative from 0.07–18%
Like those seen in previous studies, show that increasing the overall rigidity of the construct increases the stability of the fracture
Results indicate that for Vancouver B1 fractures, osteosynthesis with plate fixation has no biomechanical advantages over use of simple cerclage system – cerclage constructs demonstrated larger stiffness, larger strength, and more cycles to failure compared to plate construct

Summary

Introduction

Periprosthetic femoral fractures (PFF) is a severe complication following total hip arthroplasty (THA); the rate of intraoperative PFF ranged from 0.1–27.8% and of postoperative from 0.07–18%. Lewallen and Berry, 1998; Lindahl et al, 2006; Marsland and Mears, 2012) This number is expected to rise substantially by 2030, with the increase in life expectancy of the general population leading to a rising incidence of total hip arthroplasties (THAs), with PFF expected to rise proportionally (Della Valle et al, 2010). A previous review published in 2011 summarised the biomechanical studies regarding periprosthetic femoral fracture and its fixation techniques. The methodologies involved in the experimental and computational studies of periprosthetic femoral fracture fixation are described and compared with particular focus on the recent developments. Interpretation: The increased use of computational studies in investigating periprosthetic femoral fracture fixation techniques has proven valuable. A consensus on the ‘optimum’ treatment method for periprosthetic femoral fracture fixation needs to be achieved

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