VIDEO: Liporace gives tips for treatment, analysis of periprosthetic TKA, THA fractures
Click Here to Manage Email Alerts
Key takeaways:
- It is important to find out how the joint was functioning previously.
- There are some, but few, B2 fractures that may be reasonable to fix.
- When revising hip stems, consider long, tapered spline stems.
WAILEA, Hawaii — At Orthopedics Today Hawaii, Frank A. Liporace, MD, shared five tips for the treatment and analysis of periprosthetic fractures regarding total knee arthroplasty and total hip arthroplasty.
Liporace said the general principle of the first tip is to be concerned that all patients who have a periprosthetic fracture could potentially be infected until proven otherwise.
“History is everything. Find out how the joint was functioning prior to the incident for why you are meeting the patient in the emergency room,” Liporace said.
Liporace said if there is anything suspicious, some intraoperative modalities, like frozen section or even alpha-defensin tests, can help determine if there was a preexisting infection that contributed to the situation. He also said surgeons should be aware that mechanical instability after fracture fixation could have contributed to the patient being injured.
“Once you have done that then, you can move onto the decision-making process in terms of fix, replace or both,” Liporace said.
The second tip is that there are some, but few, B2 fractures that may be reasonable to fix.
“The majority of B2 fractures should be revised vs. revision plus fixation. However, if you have a tapered, cemented polished stem, where the cement mantle is intact around the prosthetic and there is no subsidence, you may have a consideration for fixing this fracture.”
In terms of uncemented stems, Liporace said that if the stems are proximally coated and have good fixation proximally, even if the distal aspect of the stem may appear to be loose and there is no subsidence on the proximal part, this could be a good opportunity to fix the fractures and yield a reasonable result.
The third tip is when revising hip stems, consider long, tapered spline stems, which can be either modular or one piece.
“Distal femoral replacements should be utilized cautiously, however, when necessary, in terms of distal femur fractures around total knee prostheses,” Liporace said.
Another tip was that isolated plating or nailing is usually acceptable in simple fractures.
“With severe obesity, severe comminution and severe osteoporosis, retrograde nailing combined with either a plate or locking attachment washer is a good idea to allow the same goals – immediate weight-bearing and mobilization in these patients,” he said.
Collapse
Liporace FA. Periprosthetic TKA and THA fractures: Five tips in 5 minutes. Presented at: Orthopedics Today Hawaii; Jan. 7-11, 2024; Wailea, Hawaii.
Read more about
Click Here to Manage Email Alerts