Abstract
Periprosthetic femoral fractures (PPF) are a devastating complication after total hip arthroplasty (THA). Both trauma and adult reconstruction surgeons or combined teams treat these fractures following management algorithms. The aim of this study is to investigate the current treatment of PPF by members of the European Hip Society (EHS). An online survey of the members of the European Hip Society (EHS) was conducted. 20 cases of periprosthetic fracture were presented and surgeons were asked to answer questions regarding classification, treatment and postoperative treatment protocol. A total of 132 (130 male; 2 female) EHS members responded. Mean years in surgical practice was 18.8 (min. 1 year; max. 50 years). The preferred surgical method was combined open reduction and internal fixation (ORIF) (30.3%) for AG fractures, ORIF with cables (30.4%) for AL fractures, combined ORIF (cable and plate) for B1 fractures (49.2%), stem revision with cables for B2 fractures (73.1%), stem revision with cables for B3 (55.9%) fractures and combined ORIF (cable and plate: 55.5%) for C fractures. Surprisingly, 10.8% suggested various stem revision techniques for B1 and 17.4% for C fractures. Strong variations were observed regarding postoperative weight-bearing protocol. A strong consensus was found for the choice of conservative or surgical treatment of the different PPF types according to the Vancouver Classification. Various stem revision techniques were the preferred surgical techniques for Vancouver B2 (91.2%) and B3 (88.6%) fractures. However, for postoperative weight-bearing, when the ORIF technique was used, a significant variation of protocols was found.
Highlights
Accompanying the increase in demand for primary total hip arthroplasties (THAs), an increase in complications such as periprosthetic femoral fractures (PPF) is expected.[1]
We report on the results of an online survey designed to investigate the current practices of classification, management and postoperative rehabilitation protocols of PPF by experienced European surgeons who mainly practise adult reconstruction surgery
PPFs are a severe complication of hip arthroplasty
Summary
Accompanying the increase in demand for primary total hip arthroplasties (THAs), an increase in complications such as periprosthetic femoral fractures (PPF) is expected.[1]. The major ones are the location of the fracture relative to the implant, the state of fixation of the implant, and the influence of the quality of the surrounding bone These 3 variables are described in the Vancouver Classification and form the basis for the established algorithm of management.[7] Another variable is the surgeon’s training and experience. Both trauma and adult reconstruction surgeons or combined teams, where available, currently treat these patients without uniform management strategies. Periprosthetic femoral fractures (PPF) are a devastating complication after total hip arthroplasty (THA). Both trauma and adult reconstruction surgeons or combined teams treat these fractures following management algorithms. For postoperative weight-bearing, when the ORIF technique was used, a significant variation of protocols was found
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