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Presenter discusses treatment methods for periprosthetic hip fractures
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WAIKOLOA, Hawaii — As postoperative periprosthetic fractures are becoming increasingly common, treatment methods have continued to evolve and yield promising outcomes, according to a presentation at Orthopedics Today Hawaii.
According to David Lewallen, MD, previously published research has shown a 14-fold higher rate of periprosthetic fractures with uncemented implants and a three-times higher postoperative fracture rate. When treating periprosthetic femoral fractures, he said that “fixation of the stem is critical in decision-making” and that X-rays can help.
Periprosthetic fractures can be treated in a closed fashion when the implant is stable and there is no lysis, according to Lewallen.
“If there is significant lysis, you are more likely to need surgery for those patients; or if there is displacement,” Lewallen said in his presentation.
He noted that locking plate technology has revolutionized the management of patients with periprosthetic fractures.
“By contouring these plates, they are easier to put in and it can be done with limited soft-tissue damage, sliding the plate up under the muscle,” Lewallen said.
According to Lewallen, as the fracture approaches the tip of the stem, proximal fixation becomes a weak treatment option. He noted surgeons should fix proximally and distally and bridge the fragments between. For implants that are not well-fixed, Lewallen said to internally fix the fracture.
“It is best to deal with the loose implant because you can use that surgery as a useful way to manage the fractures well using a modular taper, fluted stem,” Lewallen said. “Just like the locking plates have revolutionized the internal fixation part, these fluted modular stems have revolutionized our management of periprosthetic fractures.” – by Casey Tingle
Reference:
Lewallen D. Periprosthetic hip fractures. Presented at: Orthopedics Today Hawaii; Jan. 13-17, 2019; Waikoloa, Hawaii.
Disclosure: Lewallen reports he receives support from Acuitive, Stryker and Zimmer Biomet; is the medical director for the American Joint Replacement Registry and receives institutional support from DePuy/Synthes/J&J, Smith & Nephew, Stryker, Wright and Zimmer Biomet.