Hip international : the journal of clinical and experimental research on hip pathology and therapy
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Multicenter Study
A review of 202 periprosthetic fractures--stem revision and allograft improves outcome for type B fractures.
We report a retrospective review of the outcome of treatment of 202 periprosthetic fractures around total hip arthroplasty (THA) from two specialised arthroplasty centres. Fractures were classified according to the Vancouver classification. The aim was to evaluate treatment methods with respect to stem revision and grafting. ⋯ Periprosthetic fractures of the femur are highly complex and challenging. Stem revision for transverse B1 fractures is now considered as a viable treatment modality as this fracture configuration is difficult to control with single plating, and fixation with a long stem bypassing the distal fracture line is necessary to achieve axial stability and healing. Bone allografting, whether used as a cortical onlay or in morselised impacted form for B2 and B3 fractures enhances fracture healing.
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Periprosthetic femoral fractures (PFF) are among the more difficult and expensive complications of total hip arthroplasty. A rise in the elderly population and increase use of primary hip replacement has led to an escalating incidence. ⋯ The treatment algorithm defined by the Vancouver classification has universal acceptance. The epidemiology, etiology, classification and the management of periprosthetic femoral fractures in total hip arthroplasty are reviewed.
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Case Reports
A technique for extracting a buried Kuntscher nail from the femur during total hip arthroplasty.
We describe a novel technique that allows safe extraction of a buried Kuntscher nail during total hip arthroplasty in a patient with ipsilateral, symptomatic post-traumatic osteoarthritis of the hip. This method allows the surgeon to visualise the antegrade entry point of the nail allowing safe extraction of the device without compromising the result of the hip arthroplasty.
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A patient previously treated by cannulated screws fixation of a femoral neck fracture and plate and screw fixation of an ipsilateral shaft fracture presented for a total hip arthroplasty due to femoral head avascular necrosis. The cortical bone at the previous fracture site was weak and damage on the proximal femur was considered likely during removal of the plate. We were also concerned that a periprosthetic fracture might occur during or after the insertion of a conventional femoral stem. We used a short-stemmed femoral component for total hip arthroplasty in this patient, to avoid the risk of potential complications.
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Large acetabular defects can be reconstructed using a tantalum Trabecular Metal acetabular component with Trabecular Metal buttress augments. We asked if these reconstructions survived at short-term follow-up. Of 35 patients undergoing acetabular reconstruction with a Trabecular Metal acetabular revision system from 2006, 19 acetabular revisions associated with major bone loss in which we reconstructed the acetabulum with buttress tantalum augments or cup-cage construct combined with a Trabecular Metal shell, were available for evaluation. ⋯ Radiographic assessment showed an improvement in the position of the rotation centre of the hip, from a vertical position a mean of 3.5 cm (range 1.6-5.5 cm), to 1.4 cm (range 0.5-2.7 cm) postoperatively. The centre of the femoral head was relocated from a mean of 1.4 cm (range, -3 to 2.6 cm) lateral from the vertical at the teardrop to 3 cm (range 0.2-4 cm). Our early results suggest that buttress tantalum augments, with cup-cage construct for severe bone defects, may be an alternative to other treatment options, but a longer follow-up is necessary.