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A look at pattern, results of early periprosthetic femur fractures after uncemented THA
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Investigators of this study found most periprosthetic femur fractures that occurred within 90 days of uncemented collarless primary total hip arthroplasty had a stereotyped fracture pattern that ran through the medial cortex and resulted in a triangular fragment. They also found most fractures treated with femoral component revision successfully healed and had stable stems.
Researchers identified 30 Vancouver type B periprosthetic femur fractures that occurred within 90 days of primary total hip arthroplasty (THA). Overall, 28 hips had a stereotyped pattern with a displaced femoral neck fracture that included the lesser trochanter and a roughly triangular fragment created by a variable amount of the proximal medial femoral cortex, according to results. Researchers noted the time between arthroplasty and fracture ranged from 2 days to 88 days, with a mean time of 28 days. Investigators found the mechanism of injury was a fall from standing height (12 patients), no defined trauma (11 patients), a trip or stumble (five patients) and twisting at the hip (two patients).
Results showed 24 hips underwent reoperation with femoral component revision and fracture stabilization, while two hips underwent stem retention and fracture stabilization, and four hips underwent nonoperative treatment. Overall, the Harris Hip score improved from an average of 42 points preoperatively to 76 points postoperatively.
At latest follow-up, researchers found 21 of the 24 fractures treated with revision healed and had a stable femoral component, while all fractures treated with fixation or nonoperatively healed and were stable. Of the patients who underwent revision and did not heal, two developed infection and had subsequent procedures. Another patient had loosening of the femoral component and underwent an additional femoral revision. – by Casey Tingle
Disclosures: Taunton is a paid consultant for DJ Orthopedics and a board member for the American Academy of Orthopaedic Surgeons Evaluation Committee for Hip and Knee. Please see the full study for a list of all other authors’ relevant financial disclosures.
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