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Speaker: Knowledge of exact fracture pattern among keys to effectively treat periprosthetic hip fractures
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WAILEA, Hawaii — Periprosthetic hip fractures are challenging. To effectively treat patients with these fractures, a presenter here at Orthopedics Today Hawaii 2014 said orthopedic surgeons need to be aware of the fracture pattern and prosthesis stability.
“Patients are usually elderly with multiple comorbidities. We looked at the death rate, and it is higher than we anticipate. Surgeons should know exact pattern of fracture, prosthesis stability and bone quality,” Richard F. Kyle, MD, said.
He said published studies indicate that 4% of periprosthetic fractures are classified as trochanteric type A. These fractures occur in the peritrochanteric region and involve the greater or lesser trochanter and typically do not affect stem stability.
Richard F. Kyle
Type B fractures, which account for 87% of periprosthetic fractures, occur about or just distal to stem. Type B1 fractures are at the distal tip of a well-fixed stem and are typically treated with open reduction and internal fixation (ORIF) with prosthesis retention, Kyle said. Type B2 fractures occur around a loose or unstable stem and usually need revision of the prosthesis. Type B3 fractures occur around a loose implant with severe bone loss, and usually do not have adequate proximal femoral bone stock. They usually require proximal femoral replacement or allograft. Type C fractures account for 9% of periprosthetic fractures and occur distal to the stem tip and usually have a stable stem. They require treatment with ORIF.
Kyle advised that surgeons treating periprosthetic fractures avoid transition zones, hoop stresses and excessive force.
He said that risk factors for periprosthetic fractures include female gender, osteoporosis, rheumatoid arthritis, cortical perforation, preoperative femoral deformity, revision, and osteolysis and stem loosening.
Kyle also advised that for revision total hip arthroplasty after periprosthetic fracture, surgeons should consider use of the intramedullary rods, trochanteric osteotomy, bypass stress risers in addition to bone loss and a larger head size.
Reference:
Kyle RF. Periprosthetic fractures about the hip: How to treat. Presented at: Orthopedics Today Hawaii 2014; Jan. 19-23, 2014; Wailea, Hawaii.
Disclosure: Kyle receives royalties from Smith & Nephew, Zimmer and DJO.
