• Helmut L Laurer, Sebastian Wutzler, Susann Possner, Emanuel V Geiger, André El Saman, Ingo Marzi, and Johannes Frank.
• Department of Trauma, Hand and Reconstructive Surgery, J.W. Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
• Arch Orthop Trauma Surg. 2011 Jul 1;131(7):983-9.

IntroductionThe rate of periprosthetic femoral fractures after hip arthroplasty is rising and the estimated current lifetime incidence is 0.4-2.1%. While most authors recommend revision arthroplasty in patients with loose femoral shaft components, treatment options for patients with stable stem are not fully elucidated.MethodAgainst this background we performed a retrospective chart analysis with clinical follow-up examination of 32 cases that sustained a Vancouver type B1 or C periprosthetic fracture (stable stem).PatientsOverall 16 cases were treated by open reduction and internal fixation (ORIF) by plate osteosynthesis and 16 cases by revision arthroplasty (RA). Both groups were comparable regarding age, gender, follow-up time interval, time interval from primary hip arthroplasty to fracture and rate of cemented femoral components, but more type C fractures were treated by ORIF.ResultsFunctional outcome expressed by the median timed "Up and Go" test did not differ significantly (30 s ORIF vs. 24 s RA, P = 0.19). However, by comparable systemic complications surgery-related complications were significantly more frequent in plate osteosynthesis (ORIF n = 10 vs. RA n = 3, P = 0.03). Based on our results, further studies, preferable via a multicenter approach, should focus on identifying patients that benefit from ORIF in periprosthetic fractures. A misinterpretation of type B2 fractures with loose implant as type B1 fractures may cause implant failure in case of ORIF.ConclusionThe use of angular stable implants, additional cable wires or bone enhancing means is recommended.

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