HIP PERIPROSTHETIC FRACTURES

Abstract

Objective: Descriptive retrospective analysis of hip peri-prosthetic fractures treated surgically from 2000 to 2005 analysing risk factors and Results:

Material and Methods: 31 patients with a mean age of 77 years (56–94) were operated of a periprosthetic fracture which happened 73 months (0–300) after the index arthroplasty

Fractures were classified following the Vancouver system: 1 patient presented a type Al(3%), 4 a B1(13%), 23 suffered a B2(74%), 1 a B3(3%) and 2 patients presented a type C(6%)

The risk factors described in the literature were evaluated, as well as the different types of treatment with their clinical and radiological results.

Risk factors:

• Personal: 21(68%) patients were women

• Previous condition of arthroplasty: 22(71%) non cemented, 23(74%) total prosthesis, 3(10%) revision surgery; 13(54%) presented osteointegration, 2(8%) stable fibrous fixation and 9 (38%) were unstable; in (7%) there was subsidence

• Surgical technique: 11(52%) patients had insufficient size of the implant and 15 stems were in varus (54%)

• Bone status: 5 femur (20%) presented stress risers and 29(97%) diffuse osteopenia

• Polyethylene wear: 10(50%) of THA

• Osteolysis was observed in 21 patients (70%): 19(90%) in zone 1, 4(19%) in zone 2, 3(14%) in zone 3, 2(10%) in zone 4, 2(10%) in zone 5, 4(19%) in zone 6 and 15(71%) in zone 7. 5(24%) patients presented osteolysis in one zone, 9(43%) in two zones, 4(19%) in three zones, 2(10%) in four zones and 1(5%) in six zones

• Type of treatment: 19(61%) patients were treated with open reduction and internal fixation (ORIF) without revision of the prosthesis, 11(35%) with revision surgery plus ORIF and 1(3%) with a resection arthroplasty. Bone graft was used in only 1(3%) patient

• Type of osteosynthesis: 16(52%) only cables, 1(3%) cables and plates, 2(6%) plates and screws, 11(35%) plates and cables and screws, 1(3%) intramedullary nail

Clinical results:

• There were 0(0%) infections and 0(0%) exitus but 7(23%) patients suffered postoperative medical complications

• The mean time for allow weight-bearing was 3 months (2–6)

• For the 25 patients that achieved the complete follow up, maximum recovery was recorded after 9 months (3–13); 24(89%) patients recovered their previous status and 15(60%) had no pain. 15 patients maintained the instrumental level before the fracture and 10(66%) recovered it

Radiological results:

• The mean time for fracture union was 6 months (3–18). At the end of follow-up 1(4%) patient presented non-union

• 0(0%) patients presented mal-union, 2(8%) a refracture, and 6(24%) evolved to implant loosening

Conclusions:

1. Patients with periprosthetic fractures present a high number of previous local risk factors

2. Surgical treatment achieves a very low mortality rate and a good/excellent clinical result

3. Overuse of ORIF without prosthesis revision obtains consolidation in most cases but with a high risk of loosening