Treatment of periprosthetic femoral fractures associated with total hip arthroplasty

Aim: Periprosthetic femoral fractures represent a heterogenous type of injury with a variety of treatment options. By retrospectively analysing our data, the results of different therapeutic procedures are compared and, reviewing previously published cases, suggestions for the management have also been developed. Method: This study is based on the analysis of records and radiograph series of 43 patients (50 procedures) with peri-prosthetic fractures. 22 patients could be followed-up using the Harris Hip Score at an average of 4.8 years after injury. Results: Factors predisposing to fractures were found in 41 patients, only 9 fractures were due to an adequate trauma. According to the classification of Johansson et al., 15 fractures of type I and type II each and 20 fractures of type III were treated. In 23 cases open reduction and internal fixation (ORIF) with a plate was used, 10 fractures were stabilised by minimal osteosynthesis, in 8 cases a modular prosthesis for bone replacement was used, 6 times a revison stem was implanted, and in 2 fractures osteosynthesis of the femur could only be accomplished after the complete removal of implants. The mean Harris Hip Score was 69.9 points at the follow-up examination. Local surgical complications were more often observed than general. Conclusions: Due to their different clinical presentations periprosthetic fractures need to be managed individually and in most cases operatively. Internal fixation with a plate proved to give the best functional results for stable stem implants. Loosening stems have to be replaced by revision implants with long stems for intramedullary fixation. Alternative osteosynthetic techniques and additive minimal osteosynthesis can be favoured in special cases. Modular prostheses for bone replacement are reserved for fractures with extensive bone loss.