Treatment for Periprosthetic Femoral Fractures after Total Hip Arthroplasty

PURPOSE OF THE STUDY To give a description of the patient group, risk factors, classification, therapeutic procedures and treatment outcomes in periprosthetic femoral fractures after total hip arthroplasty treated in the Trauma Hospital in Brno. MATERIAL AND METHODS This retrospective study comprised of 51 patients treated for a periprosthetic femoral fracture between 2003 and 2013. This included 19 (37%) intra-operative and 32 (63%) post-operative fractures. According to the Vancouver classification, the types of fractures were as follows: 9 patients A; 21 B1; 9 B2; 6 B3 and 6 with type C. RESULTS Type A fractures were treated conservatively. Although pseudoarthrosis of the greater trochanter occurred, the patients had no clinical problems. The intra-operative type B1 fractures were managed by cerclage tapes in nine patients and the post-operative B1 fractures were treated by plate osteosynthesis in 10 patients and femoral stem reimplantation in two patients. All post-operative type B2 and type B3 fractures were managed by reimplantation of the femoral stem and type C fractures were treated by plate osteosynthesis. Serious complications requiring revision surgery were recorded in five patients; they included plate failure in two B1 fractures, dislocation of a B2 fracture, a dislocation with femoral component rotation in a B3 fracture and failure of the plate in a type C fracture. CONCLUSIONS The treatment of a periprosthetic fracture can affect the patient's life. In view of the fracture type, implant type, general health of the patient and all risk factors, the authors prefer one-stage surgical treatment. The Vancouver classification is a guidleine for the therapeutic plan. Osteosynthesis as a single procedure is indicated only if the femoral component is stable and well fixed. When the stem in B2 and B3 fractures is loose, revision surgery with stem replacement is necessary.