The location of the fracture determines the better solution, osteosynthesis or revision, in periprosthetic femoral fractures

Abstract

PurposePeriprosthetic femoral fractures are difficult to treat, but few reports have included many periprosthetic femoral fractures. The purpose of this study was to investigate the trends and characteristics of a large number of periprosthetic femoral fractures and to determine the best treatment strategy for such fractures. MethodsThe fracture type according to the Vancouver classification, the stem fixation style of previous surgery, the elapsed time from previous surgery, and the treatment method for periprosthetic fractures of 51 patients with periprosthetic femoral fractures who were seen between 2006 and 2018 were investigated. ResultsThe types of fractures according to the Vancouver classification were: type A 5.9%, type B1 47%, type B2 20%, type B3 2.0%, and type C 25%. Of the previous surgeries, 76% were cementless fixation, and 24% were cemented fixation. The mean duration from previous surgery to periprosthetic femoral fracture was 8 years and 7 months (1–358 months), and injury within 1 year from previous surgery was most commonly observed (24%). As treatment for periprosthetic femoral fractures, conservative treatment was performed in 8%, and surgery was performed in 92%. Of the surgery cases, 53% underwent osteosynthesis, and 39% underwent revision surgery. Of type B1 surgery cases, 58% were treated with osteosynthesis, and 33% underwent revision surgery, although type B1 had no stem loosening. ConclusionMany periprosthetic femoral fractures occurred within 1 year after the previous surgery. Therefore, preventive measures for periprosthetic femoral fractures should be started immediately after total hip replacement. In addition, revision surgery was performed even if the stem was not loosened in cases where it was judged that sufficient osteosynthesis could not be performed.