Treatment Of Periprosthetic Fractures Research Articles

Locking Attachment Plate for the Surgical Treatment of Periprosthetic and Periimplant Fractures: Long-Term Follow-Up.

The surgical management of periprosthetic fractures (PPF) and periimplant fractures (PIF) can be challenging. The locking attachment plate (LAP) was proposed in recent years for the osteosynthesis of such fractures. The aim of this study was to assess the experience of a third-level hospital with LAP for the treatment of PPF and PIF, and analyse the clinical outcomes. Data were prospectively collected and analysed from all patients whose PPF/PIF was treated surgically with LAP in a third-level hospital from June 2018 to June 2022. All fractures were postoperative low-energy femur fractures. The minimum follow-up period was six months. Thirty-eight patients (31 women) met the eligibility criteria. The mean age was 86.3 years. The median time until surgery was 4 days. A mean of 3.61 screws were used for each LAP. The mean femur plate length was 14 holes, and the mean working length 7.1 holes. The median hospital stay was nine days. The mean follow-up was 19.56 months. At one month, 12 patients tolerated partial weight-bearing. Five patients walked independently indoors. One patient had died and seven patients were readmitted. At six months, six more patients had died. Fifteen patients tolerated full weight-bearing (FWB). Nine patients walked independently indoors, six outdoors. Twenty-five patients reached fracture consolidation without malalignment. Nine patients were readmitted. At 12 months, another patient had died. Seventeen patients tolerated FWB. Eleven patients walked independently indoors, six outdoors. Twenty-five patients achieved fracture consolidation without malalignment. Five patients were readmitted. Fourteen patients crossed the two-year postoperative threshold. All achieved fracture consolidation. Two patients passed the 4-year postoperative milestone. The clinical results of patients whose PPF or PIF was treated with the LAP are promising. This fixation method is a viable option to be considered when planning surgery for such fractures.

Operative treatment of periprosthetic fractures of the proximal femur with a contralateral, upside-down LISS plate in elderly patients

BackgroundIncreasing expectancy of life and levels of activity in the growing geriatric population lead to a rising number of prosthetic implants of the hip and consequently the incidence of periprosthetic fractures of the femur increase. The fracture pattern and the possible instability of the stem are a challenge to the orthopaedic surgeon. Treatment options are complete replacement of the implant or a solitary osteosynthesis. The goal of this study was to analyse the feasibility of the operative intervention using a contralateral reversed anatomic distal femoral LISS® locking plate and the radiological and functional outcome in a geriatric cohort.MethodsWe included all patients older than 75 years of age with a Vancouver type B fracture, which have been treated by osteosynthesis using a LISS® (contralateral reversed) plate in our institution in an interdisciplinary ortho-geriatric setting between 7/2013 and 12/2021. Perioperative morbidities, clinical and radiological outcome during follow-up were retrospectively analysed.ResultsDuring the observed time period, 83 patients (mean age: 88 years (range: 76–103), male/female: 26/57) were treated. Most fractures were Vancouver type B2 (n = 45, 54%) followed by B1 (n = 20, 24%) and B3 (n = 18, 22%). The most prevalent postoperative surgical complication was anaemia (n = 73, 88%) followed by infections (n = 12, 14%, urinary infections, pneumonia) and cardiovascular decompensation (n = 8, 10%). Clinical and radiological follow up 6–8 weeks postoperative was possible for 59 patients (70%). The majority of them did not describe pain (n = 50, 85%) and had a good or excellent radiological outcome. Three cases needed revision surgery due to infection and another three due to non-union, loosening of the stem or an additional fracture. 1-year mortality was 30%.ConclusionWe are convinced that the reversed contralateral LISS-plate is an easy-to-use implant with a small complication rate but a very successful and high healing rate in a geriatric, polymorbid cohort.

Treatment of Periprosthetic Fracture of the Proximal Humerus with Structural Allograft

Treatment of Periprosthetic Fracture of the Proximal Humerus with Structural Allograft

Outcomes of osteosynthesis of periprosthetic fractures of the greater trochanter with an anatomic claw plate

BackgroundThe treatment of periprosthetic trochanteric fractures, especially older fractures, is often a challenge. The aim of this study was to investigate the clinical and radiological outcomes of periprosthetic fracture treatment with the anatomic Peri-Plate claw plate. Material and methodsThirteen new fractures (≤6 weeks after occurrence) and 8 older Vancouver AG fractures (35.4 ± 26.1 weeks after occurrence) were followed radiologically and clinically with a follow-up of 44.6 ± 18.8 (24–81) months. ResultsAt 6 months, osseous consolidation had occurred in 12 cases and fibrous union in 9 cases. At 12 months one additional osseous consolidation was shown. The Harris hip score (HHS) increased from 37.2 ± 10.3 preoperatively to 87.6 ± 10.3 12 months after surgery. Thirteen patients reported no, 7 mild and one patient significant local trochanteric pain. ConclusionsThe Peri-Plate claw plate can achieve reproducibly good outcomes in terms of fracture stabilization and bony consolidation, as well as with regard to clinical outcomes in the treatment of new and older periprosthetic trochanteric fractures.

Revision der inversen Schulterprothese

In recent years, the number of reverse shoulder arthroplasty implantations has increased continuously and ahigher number of revision surgeries due to complications can be expected in the future. Current data show amean complication rate for RSA of around 4%. The most common complications are instability, infection, component loosening, and periprosthetic fracture. Revision surgery for RSA is challenging, and an individual treatment plan is necessary. For prosthetic instability, different operative or non-operative treatment options are available. Revision surgery for periprosthetic infection with replacement of the prosthesis is usually necessary for infection management. The treatment of periprosthetic fractures is based on techniques of general fracture treatment and depends on the fracture type. Knowledge of complications and risk factors may decrease complication rates in primary reverse shoulder arthroplasty in the future.

Re-revision hip replacement in peri prosthesis shaft femur fracture in operated case of cemented total hip replacement

Introduction: Revision surgery differs from original total hip replacement surgery, which is a lengthier and more difficult process. To get a satisfactory result, substantial preparation is required, as well as the use of specialised implants and instruments. Periprosthetic fractures are most commonly caused by a fall and frequently necessitate revision surgery. Most modifications will include the use of customised implants intended to compensate for compromised bone and soft tissue. Case Report: 68-year-old male with bilateral cemented total hip replacement presents with peri prosthetic shaft femur fracture in left side without DNVD which was van-couver type B2 managed with ORIF + Platting + TBW loop which eventually failed, impairing the patient's routine activity, so he came to SMIMER hospital. Management: We performed implant removal + revision total hip replacement with long stem femoral component, which failed post-operatively, therefore the patient underwent Re-revision surgery with inter locking nail femoral long stem component. During repeated follow-ups, the patient expressed satisfaction with his everyday activities. Discussion: Complication are common in revision surgery. Early management is key to rectify intra operative and post-operative complication. Periprosthetic femoral fractures after total hip replacement is a rare but feared complication. Peri prosthetic fracture is managed based on fracture pattern and stem and bone stock. Conclusion: Surgical treatment of periprosthetic fractures, thanks to the introduction of new implants for osteosynthesis and development of new stems for revision endoprostheses, helps achieve ever better results. Of major importance for choosing the treatment method is correct classification of fracture and stem stability.

Treatment of Periprosthetic Fractures in Total Hip Endoprosthetics: A Modern Review of Surgical Opportunities

Treatment of Periprosthetic Fractures in Total Hip Endoprosthetics: A Modern Review of Surgical Opportunities

Periprosthetic fractures-Diagnostics, classification and treatment

Due to the increase in hip and knee prosthetic as a result of the demographic changes, with raised levels of activity among older persons with geriatric comorbidities, acontinuous increase in periprosthetic fractures can be observed. The incidence and causes of periprosthetic fractures, presentation of diagnostic pathways and derivation of a recommendation according to generally accepted classifications. Literature search of basic scientific work, recommendations of experts as well as evaluation of own patient collective. With agrowing number of prosthetic interventions in combination with increasing patient age, an increase in periprosthetic fractures is to be expected. The treatment of periprosthetic fractures is complex and requires detailed analysis of the location of the fracture and its morphology as well as the recognition of possibly loosened prosthetic material. Based on this information, the correct surgical treatment can be determined and scheduled in an appropriate center of care. In geriatric patients with corresponding comorbidities, an individual holistic treatment plan should be developed.

A case of staged revision cementless Total Hip Arthroplasty following post traumatic periprosthetic Vancouver type B fracture after hemiarthroplasty

The overall incidence of different types of periprosthetic fractures is on the rise constantly due to the increasing volume of primary joint arthroplasties and revision arthroplasties. Skills pertaining to advanced complex trauma and arthroplasty are necessary to manage these injuries. Inspite of various algorithms and classifications available regarding management of these injuries, it is necessary for the treating surgeon to understand that the treatment of periprosthetic fractures needs to be individualised optimal for that particular patient. We present our experience in a case of post traumatic periprosthetic Vancouver type B fracture after hemiarthroplasty treated with staged revision cementless long stem Total Hip Arthroplasty(THA).

Concepts and Potential Future Developments for Treatment of Periprotethic Proximal Femoral Fractures

Periprosthetic proximal femoral fractures are a major challenge for the orthopedic surgeon, with a continuously increasing incidence due to aging populations and concordantly increasing numbers of total hip replacements. Surgical decision-making mainly depends on the stability of the arthroplasty, and the quality of bone stock. As patients final outcomes mainly depend on early mobilization, a high primary stability of the construct is of particular relevance. Osteosynthetic procedures are usually applied for fractures with a stable arthroplasty, while fractures with a loosened endoprosthesis commonly require revision arthroplasty. Osteoporotic bone with insufficient anchoring substance for screws poses one major concern for cases with well-fixed arthroplasties. Complication rates and perioperative mortality have remained unacceptably high, emphasizing the need for new innovations in the treatment of periprosthetic fractures. Taking into account the presence of an intraosseous implant, we chose the tactics of surgical intervention using techniques that allow rigid fixation of the fragments of a periprosthetic fracture, which creates uniform compression around the stem of the endoprosthesis, which reduces the risk of loosening of the joint components in the interoperative and postoperative period: a technique with the use of a special plate.

Periprosthetic fractures of total hip arthroplasty: a review of literature with a point of view

Periprosthetic fractures associated with total hip arthroplasty are becoming increasingly more common. The purpose of study is to review the treatment of periprosthetic fractures of total hip arthroplasty. A limitated number of cases is proposed. Careful intraoperative technique and tissue handling are crucial to reduce periprosthetic fractures. Once identified, however, any number of well described the treatment options are available for the surgeons. Carefully approached, and using sound treatment principles, these fractures can be appropriately addressed, thus ensuring adequate patient results. In this review, there are not outcome and tables.

To Analyze the Outcomes of Various Methods of Treatment of Periprosthetic Fracture Following Hip Arthroplasty- A Restrospective Study to form the Optimal Treatment Guidelines

Background: Periprosthetic fracture of femur after total hip arthroplasty (THA) is a well known complication. Mayo clinic joint registry has reported 1.1% incidence of periprosthetic femoral fractures after primary THA and 4% incidence after revision THA. This study was conducted to analyse the results of various methods of treatment of periprosthetic fractures following THA and to form the optimal treatment guidelines for fixation or revision surgeries.

Diagnosis and treatment of periprosthetic fracture after medial unicompartmental knee arthroplasty

Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage anteromedial osteoarthritis of the knee. Medial tibial plateau fracture or femoral condyle fracture may occur after UKA, and its treatment is very challenging. The causes leading to this complication include: surgical technique errors, such as the weakening of posterior cortical strength of the tibial platform during operation, the reduction of bone mass due to too much tibial osteotomy, and the stress concentration in the bone bed due to bad alignment of the prosthesis, etc. Prosthesis design factors, such as press-fit fixation design of cementless UKA prosthesis, and multiple nail holes fixation for tibial osteotomy guide, etc. And the morphology of tibial plateau, such as tibial platform in Asian people with narrow and small shap and medial overhanging condyles. Correct selection of patients, strict surgical principles and standardized surgical techniques are the keys to prevent periprosthetic fractures during and after medial UKA. After the diagnosis is confirmed, the treatment choice mainly depends on the fracture pattern and the stability of the prosthesis.

Metallic versus Non-Metallic Cerclage Cables System in Periprosthetic Hip Fracture Treatment: Single-Institution Experience at a Minimum 1-Year Follow-Up.

Metallic cerclage cables are reliable and cost-effective internal fixation devices, which are largely used in surgical practice for the treatment of periprosthetic fractures. Nevertheless, complications connected with their use have been described in the literature, including the following: third-body generation, failure and consequent migration, fraying, allergies, and injury to the surgical team. The development of new materials offers alternatives to traditional metallic cables. This study compares the outcomes between two groups of patients affected by periprosthetic hip fractures, treated with titanium cables or with ultra-high-molecular-weight polyethylene (UHMWPe) iso-elastic cables. Our retrospective study aims to compare the clinical and radiological outcomes of titanium cables and UHMWPe iso-elastic cables, isolated or associated with dedicated plates, for the surgical treatment of periprosthetic fractures with stable implants. Two groups of 30 (group A—metallic cables) and 24 (group B—UHMWPe iso-elastic cables) patients have been surgically treated in our institution for hip periprosthetic fractures, between September 2017 and June 2020. The mean age of the patients was 81 years in group A and 80 years in group B. In our study, we included fractures classified as B1 or C, according to the Vancouver postoperative fractures classification; the patients were evaluated retrospectively at 1 year postoperatively, regarding the following: surgery time, blood loss, partial weight-bearing time, radiographical healing time, Harris hip score, and postoperative complications. Comparable outcomes were observed in patients from both groups. Group A showed a higher complication rate compared to group B, at 1 year postoperatively. Non-metallic nylon fiber and ultra-high-molecular-weight polyethylene (UHMWPe) cerclage cables could represent a reliable fixation device, ensuring comparable healing and complication rates with traditional titanium cerclage cables.

Сучасний стан лікування перипротезних переломів стегнової кістки

У статті наведено аналіз літературних даних з проблеми лікування перипротезних переломів. Показано різні підходи до вирішення цієї складної проблеми. Наведені спроби уніфікованого підходу до лікування перипротезних переломів, наголошено на відсутності єдиної загальноприйнятої тактики їх лікування.

Outcomes of the Surgical Treatment of Periprosthetic Fractures Around the Knee with Locking Plates: A Single Centre Experience.

Introduction:Surgical treatment options for periprosthetic fractures (PPF) include internal fixation with plate, intramedullary nailing and revision arthroplasty. We aimed at evaluating the surgical outcomes of patients who we had treated PPF with locking compression plates (LCP).Materials and methods:Twenty patients with PPF after primary total knee arthroplasty (TKA) between 2009 and 2016 were included in to the study. Knee Society Knee Scoring System (KSKSS) was used in the evaluation of radiologic and functional outcomes. There were periprosthetic supracondylar femoral fractures in 15 patients, and that of tibial fractures in 5 patients. For internal fixation, locking compression plate was preferred.Results:The mean age was 69 (range 61 to 78) years and the mean follow-up period was 72.25 (range 24 to 110) months. Union was achieved by 15.8 weeks in all the cases. Superficial infection and implant fracture were each seen in two patients. Revision operations were done to those patients with implant fracture. Mean KSKSS was 81.4 (75-87) and the mean functional score was 78.75 (75-85). Degenerative osteoarthritis patients were found to have higher age values than post-traumatic osteoarthritis patients (p = 0.001). When the union times were compared, it was found that the degenerative osteoarthritis patient group had a significantly shorter union than the post-traumatic osteoarthritis patient group (p = 0.036).Conclusion:Internal fixation with LCP is an effective treatment method in managing of PPF for patients with good bone stock. Rigid fixation should be done with the right surgical technique and an early movement must be initiated so that a good function can be achieved.

Surgical Treatment of Periprosthetic Fracture of Femur after THR

Surgical Treatment of Periprosthetic Fracture of Femur after THR

Comparison of different fixation techniques for periprosthetic fractures: a biomechanical study of a new implant.

The ideal treatment method for periprosthetic fractures is controversial due to the risks of current methods. Single-cortex screw fixation in prosthesis may lead to implant failure. Therefore, we aimed to develop an implant that lowers the risk for complications. For this study, we designed and tested two new implant models. The first model was a plate with a combination of U nails and cerclage holes. The second model was a U nail plate with a screw, which combines a plate screw with U nail (staples). Our study aimed to compare the stability of two newly designed implants with classical treatment modalities. We used 27 (in 3 groups) artificial bone models and 9 different test models. The ISO 7206-4:2010 (E) standards were used for 27 bones in nine groups tested under laboratory conditions. In our study, we examined nine different groups. In group 1, hipthe prosthesis was extracted, and a revision femoral stem was embedded. In group 2, periprosthetic fractures were repaired with a plate and cable. In group 3, periprosthetic fractures were repaired with a plate and stapler. In group 4, periprosthetic fractures were repaired with a plate and stapler cable. In group 5, periprosthetic fractures were repaired with a plate stapler and screw. Groups 6 and 7 were the control groups. Group 6 was the only artificial bone group, and group 7 was the prosthesis embedded bone group. Group 8 was periprosthetic fractures treated with unicortical screw fixation with cerclage, and group 9 was periprosthetic fractures treated with unicortical screw fixation. Axial loading was applied to the bones. The yield strength of the system was determined by loading the synthetic bone models with a constant compression speed of 5 mm/min through the centre of motion using the Geratech SH 2000 testing system. During the tests, load and displacement values were recorded, and the stiffness of the models was calculated based on those values. According to our results, the greatest durability was found in the revision hip prosthesis group (1511 N), and the weakest performance was found in the plate with the stapler implant group (163N). When comparing the data of groups according to compression, significant differences were found in group 2 with groups 1, 4, 5, and 7; group 3 with group 1; group 8 with groups 1 and 5; and group 9 with 1, 5, 7, and according to breakage, significant differences were found in group2 with groups 1, 3, 5, and 7; group 3 with group 1; group 8 with groups 1 and 5; and group 9 with groups 1, 5, and 7 (p<0.001). The revision hip prosthesis treatment for periprosthetic fractures showed the best performance, followed by the plate with stapler screw. In older patients, U nail-augmented implants may be a good alternative for periprosthetic fractures. Unicortical screw and cerclage wire combination fixation results were unsatisfactory results in this study. This is an experimental study, so further studies, especially patient-specific studies, should be made to expand the findings of this study.

Modular megaprostheses in the treatment of periprosthetic fractures of the femur.

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.

Osteosynthesis in Vancouver type B1 periprosthetic fractures

Introduction: The incidence of hip periprosthetic fractures (PPF) has been increasing in recent years. In Vancouver type B1 there are several osteosynthesis options. The aim of this paper is to assess both the treatment and results of Vancouver type B1 PPF in patients operated at our centre. Material and Method: An observational retrospective study of patients operated at Hospital Universitario Miguel Servet for type B1 PPF via osteosynthesis with plate between January 2014 and March 2017. Such details were documented and analysed as type of implant used for fixation, patient demographics, complications, time to union and function score using the Harris Hip Score. The minimum follow up was 2 years. Results: Overall, 37 patients (21 women) were available for review with a mean age of 80.7 years (range 54–99). 8 of these patients died, with an average age of 85.6 (83–95). Out of these 8 dead patients, 4 died in the first year, with an average age of 87 (83–95). 19 fractures had cemented stems whereas 18 were uncemented. According to prosthesis type, 8 had a cemented partial arthroplasty, 11 a cemented total hip arthroplasty (THA), 18 a non-cemented THA; with an average period until PPF of 2.5 years (0.2–5.6), 7 years (0.09–18.1) and 8.1 years (2.6–12.7) respectively. Devises used for stabilisation of the fracture included 27 Cable-Ready® plates (Zimmer–Biomet), 5 Dall-Miles® plates (Stryker) and 5 femur NCB® plates (Zimmer-Biomet). Complications included 5 acute superficial infections of surgical wound, 1 chronic infection, 5 pressure ulcers (4 sacral, 1 heel), 7 patients required intra-operational blood transfusion. The mean time to union was 10.35 weeks (range 6–13). The mean Harris Hip Score postoperatively was 65 (44–95). Discussion: Treatment via open reduction and internal fixation with locked lateral plate covering most of the femur in elderly patients or those with poor bone quality, or a plate with proximal cerclages and distal screws in patients with better bone quality are appropriate treatment methods. To achieve good results using these techniques, we consider minimisation of soft tissue dissection highly important likewise using a meticulous osteosynthesis technique with special attention to biology and biomechanics.