Abstract
INTRODUCTION
The purpose of this study was to determine the rate of complications and re-operations after operative treatment of peri-prosthetic femur fractures sustained within 90 days following primary total hip arthroplasty (THA).
METHODS
4,433 patients (5,196 consecutive primary THAs) over 10 years at a single institution were retrospectively reviewed. Thirty-five (0.67%) peri-prosthetic fractures that were treated operatively in 32 patients were identified and classified using the Vancouver Classification. There were 9 patients with a type Ag fracture, 2 patients with a type B1 fracture, 17 patients with a type B2 fracture, 1 patient with a type B3 fracture, and 3 patients with a concomitant type Ag and B2 fracture. Eleven (34%) patients were treated with isolated ORIF: greater trochanter (9) or femoral shaft (2). Twenty-one (66%) were treated with femoral revision combined with (14) or without (7) attempted fracture fragment reduction; a diaphseal engaging stem was utilized in all revisions. One patient was lost to follow-up leaving 31 patients for evaluation
RESULTS
Nineteen (61%) patients sustained twenty-two major complications including non-union of the greater trochanter in 10 of the 12 Ag fractures, three Brooker grade 3 heterotopic ossification (10%), non-unions of both B-1 fractures (6%), two deep infections (6%), one stem subsidence that required repeat revision (3%), one greater trochanteric fracture with instability (3%), one non-union of an extended trochanteric osteotomy, one hematoma (3%) and one peroneal nerve palsy (3%). Seven patients (23%) required a second operative procedure for management of a complication and one patient required a third operation.
CONCLUSIONS
Operative treatment of acute post-operative periprosthetic fractures is associated with a high rate of major complications (61%) and re-operation (23%). Operative treatment of acute post-operative fractures of the greater trochanter was associated with non-union in 10 of 12 cases (83%).
