The effectiveness ORIF for neglected periprosthetic femoral fractures after hemiarthroplasty: A case report

INTRODUCTION AND IMPORTANCE

Periprosthetic fractures are a growing concern due to the increasing frequency of primary joint replacement surgery, with total hip arthroplasty being the most common. The incidence of periprosthetic fractures after revision surgery ranges from 4 to 11 %, with up to 30 % reported after knee revision surgery. This case report aims to describe the treatment of an 81-year-old woman suffering from neglected periprosthetic femoral fracture post hemiarthroplasty.

CASE PRESENTATION

An 81-year-old woman with a history of hemiarthroplasty surgery and hypertension was admitted to the ER with pain in her right thigh. She had a middle shaft femoral fracture and was scheduled for open reduction and internal fixation. Despite being fully conscious and having an average pulse rate and blood pressure, she had cardiomegaly and congestive pulmonum. Unfortunately, this patient did not receive appropriate medical treatment after it occurred for 1 month. After surgery, we evaluated the implant, and the implant stabilized the fracture. After 1-3 months after surgery, the LEFS (The Lower Extremity Functional Scale) score was found that the score increase significantly after surgery.

CLINICAL DISCUSSION

The Vancouver classification system manages periprosthetic fractures by assessing location, stability, and bone quality. Type A fractures involve the trochanter, while type B fractures are diaphyseal and can extend distally. ORIF is used for subtype B1 fractures, but newer techniques offer shorter operating times and fewer complications.

CONCLUSION

From this study, we can conclude that even though neglected cases procedure with ORIF promises a good outcome based on clinical evaluation.

Periprosthetic fracture as a late mode of failure of the Anatomique Benoist Girard II femoral prosthesis

Aim

The Anatomique Benoist Girard (ABG) II femoral implant was a commonly used stem for primary total hip replacement (THR) at our institution (Launceston, Tasmania Australia). We identified peri‐prosthetic fracture as the main cause of late failure.

Methods

The late periprosthetic fracture rate for ABG II implants was reviewed with national statistics, using Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data. National revision rates for periprosthetic fracture were used to compare ABG II with all other cementless femoral stems.

Result

ABG II stems accounted for 1% (2719 implants) of all femoral stem implants in Australia during the 12‐year review period, compared to 23% (587 implants) in Launceston Hospitals. Although the Launceston cumulative percent revision rate for the ABG II stem was lower than the National rate at all time points, the reasons for revision were similar. The most common reason for revision of ABG II was fracture (56.8%), followed by loosening (15.3%). This differs from the reasons for revision in other cementless prostheses (loosening 23.9%, fracture 20.8%, dislocation 18.7%). Cumulative percent revision rates from late periprosthetic fracture, were higher for the ABG II stem than other cementless femoral prostheses.

Conclusion

This review of the AOANJRR has confirmed a local and national higher revision rate of the ABG II stem due to late periprosthetic fracture compared with other cementless stems. Stem design must be considered to reduce the risk of late periprosthetic fracture.

Osteosynthesis and outcomes of traumatic periprosthetic femoral fractures after total hip arthroplasty

PURPOSE

The aim of this retrospective study was to investigate the treatment of traumatic periprosthetic femoral fractures with open reduction and internal fixation. The outcomes with the use of the surgical techniques were also reported.

METHODS

Between September 2017 and September 2019, 25 patients with traumatic periprosthetic femoral fractures were managed by open reduction and internal fixation in Ain Shams University Hospital, Egypt. The fixation methods were selected based on the surgeon's preference. Outcomes were assessed using the Harris Hip Score, visual analogue score (VAS) for pain, and EuroQol 5 Dimensions - 5 Level (EQ5D-5L) prior to and after surgery. Patients were regularly followed up for one year. A P value < 0.05 was considered to be statistically significant.

RESULTS

The mean age at surgery was 77 years (range, 51 to 95 years), 64% (n = 16) were females. According to the Vancouver classification, there were 1 type AG, 15 type B1, and 9 type C fractures. Postoperative complications included wound site infection (n = 2) and non-union (n = 1). The mean pre-trauma Harris Hip Score was 77.44 ± 8.63 (range, 65 to 90), and the mean Harris Hip Score collected at the final follow-up was 72.47 ± 8.85 (range, 60 to 86) (P < 0.05). The mean pre-trauma VAS was 2.20 ± 1.21 (range, 0 to 4), and the mean VAS recorded at the final follow-up was 3.00 ± 1.41 (range, 0 to 5) (P < 0.05). According to the EQ5D-DL assessed at the final follow-up, no patient felt that their daily life and activities became more problematic.

CONCLUSION

This study provided added validation of the current management of periprosthetic femoral fractures after total hip arthroplasty. Using the proper fixation and implant can achieve a reliable fixation and good functional recovery.

LEVEL OF EVIDENCE

IVa.

Biomechanics of Implant Fixation in Osteoporotic Bone

PURPOSE OF REVIEW

The purpose of this review is to critically evaluate the current literature regarding implant fixation in osteoporotic bone.

RECENT FINDINGS

Clinical studies have not only demonstrated the growing prevalence of osteoporosis in patients undergoing total joint replacement (TJR) but may also indicate a significant gap in screening and treatment of this comorbidity. Osteoporosis negatively impacts bone in multiple ways beyond the mere loss of bone mass, including compromising skeletal regenerative capacity, architectural deterioration, and bone matrix quality, all of which could diminish implant fixation. Recent findings both in preclinical animal models and in clinical studies indicate encouraging results for the use of osteoporosis drugs to promote implant fixation. Implant fixation in osteoporotic bone presents an increasing clinical challenge that may be benefitted by increased screening and usage of osteoporosis drugs.

Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement

OBJECTIVE

 The aim of this study was to report outcomes in dogs with periprosthetic femoral fractures associated with a press-fit cementless femoral total hip replacement implant.

MATERIALS AND METHODS

 Electronic medical records and digital radiographs were used to identify dogs with periprosthetic femoral fractures associated with press-fit cementless total hip replacement. Data collected included signalment, weight, time of fracture, cause of fracture, presence of intra-operative fissure, fracture type, repair technique, and clinical and radiographic outcomes. Long-term patient outcome was assessed by communication with owners or referring veterinarians.

RESULTS

 Twenty-eight dogs with femoral fracture repair associated with cementless press-fit total hip replacement were identified. Eight of the fractures occurred intraoperatively and 20 occurred at a median of 2 days postoperatively. An oblique or spiral configuration was noted in 19 cases and 15 occurred at the distal end of the femoral stem (type B), with thirteen type B1, one type B2 and one type B3 fractures. Fractures were repaired with non-locking (18/28) or locking-plate fixation (10/28). Cerclage wire was applied around the plate and proximal bone segment in 17/28 dogs. Major complications occurred in 7/28 cases (five deep infection, two mechanical failures). Bone healing was noted in 21/23 cases, for which follow-up radiographic interpretation was available. Return to function was complete in 17 cases, acceptable in 8 cases and unacceptable in 3 cases.

CONCLUSIONS

 While cementless total hip replacement periprosthetic femoral fractures can be successfully repaired with lateral plate fixation, the risk of infection appears to be high.