Treatment of Periprosthetic Femoral Fractures after Total Hip Replacement. Literature Review

Abstract

Peri-prosthetic femoral fractures are a serious problematic complication after primary and revision hip replacements. These fractures are associated with adverse outcomes, heavy mortality and often incomplete functional recovery.The aim of this review article is to study the frequency and factors that contribute to the occurrence of peri-prosthetic fractures of the proximal femur (PFPF) after total hip arthroplasty (THA). In order to achieve this goal, we conduct a comprehensive search in medical literature in the MEDLINE and EMBASE databases in order to familiarize with publications related to PPFF, their frequency and risk factors. The study showed that the frequency of PPFF after primary THA is generally lower than after revision, both for intraoperative and postoperative cases of PPFF. The frequency of intraoperative fractures varies from 0.1% to 27.8%, and postoperative fractures from 0.07% to 18%. Bone loss, rheumatoid joint inflammation, surgical technique of open treatment, the use of cementless stem and revision hip arthroplasty are predisposing factors for intraoperative PPFFs. In the case of postoperative PPFF, significant risk factors are old age, female gender, post-traumatic osteoarthritis, bone loss and rheumatoid joint inflammation, deformities of the proximal femal bone, previous operations on the affected hip joint, the type of implant (especially cementless stems and molds).Key words: endoprosthesis replacement, periprosthetic fracture, femur, proximal femur, hip joint, osteosynthesis.