VIDEO: Treat patients with periprosthetic fractures to allow for immediate weight-bearing
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KOLOA, Hawaii — In this video from Orthopedics Today Hawaii, Frank A. Liporace, MD, spoke about periprosthetic fractures.
“The one thing that we have to understand is with the volume of total joints that are going into place and the rapidly expanding over 65-year-old population in our demographic, it is important that we are all together in treating these patients in a quick way that allows for immediate weight-bearing,” he said.
He said weight-bearing as tolerated is important in these patients and operating within 24 to 48 hours, if medically stable, makes sense because these patients share the same morbidity and mortality profile as hip fracture patients.
“What goes hand-in-hand with that is doing competent fixation and realizing when we have to revise, especially in the hip,” Liporace said.
Concerns of plating a patient with a loose implant can be issue if it is going to limit weight-bearing, he said.
“We should consider long-stem revisions with the combination of fixation to allow the patient in the short-term to be able to bear weight through the implant that is applied during the revision and reconstitute the tubercle of the femur for ultimate healing of the muscle attachments,” he said.
In the knee, Liporace said there are many options that exist, including nail and plate combinations that allow for early weight-bearing in precarious situations.
“We should not neglect thinking about distal femoral replacements in certain situations where the bone is [not] reconstructible and the implant is loose,” he said.
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