Periprosthetic Femoral Fractures after Hip Arthroplasty

Joong Myung Lee

doi:10.5371/jkhs.2011.23.3.174

Abstract

Periprosthetic femoral fractures are increasing. In a periprosthetic femoral fracture, treatment is difficult and complications are common. The result of total hip arthroplasty becomes poor. The study sought to determine the cause and risk factors of periprosthetic femoral fracture after total hip arthroplasty, and discusses treatment according to the guidelines of the Vancouver classification.

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Fig. 1.

(A) Preoperative radiograph of the left hip showing Vancouver type A (A_L+A_G) periprosthetic femoral fracture. (B) Postoperative radiograph showing that fracture is reduced and fixed with cerclage wiring.

Fig. 2.

(A) Preoperative radiograph of the right hip showing Vancouver type B1 periprosthetic femoral fracture. (B) Postoperative radiograph showing that fracture is reduced and fixed with plate, screws and wires.

Fig. 3.

(A) Preoperative radiograph of the left hip showing Vancouver type B2 periprosthetic femoral fracture pattern characterized with loosening of stem and good quality of femoral bone. (B) Postoperative radiograph showing that the stem is changed with long revision stem and fracture is reduced and fixed with cerclage wires.

Fig. 4.

(A) Preoperative radiograph of the right hip showing Vancouver type B3 periprosthetic femoral fracture pattern characterized with loosening of the stem and poor quality of femoral bone. (B) Postoperative radiograph showing that the stem is changed with long revision stem and fracture is reduced and fixed with cerclage wires.

Fig. 5.

(A) Preoperative radiograph of the right hip showing Vancouver type C periprosthetic femoral fracture pattern. (B) Postoperative radiograph showing that fracture is reduced and fixed with plate, screws and cerclage wires.

Table 1.

Risk Factors Associated with Periprosthetic Femoral Fracture

General Factors	Local Factors
Osteoporosis	Loose Prosthesis
Primary	Localized Osteolysis
Secondary	Stress riser within the Cortex
Female Sex	Screws Holes
Osteopenia	End of Plate
Rheumatoid Arthritis	Cortical Defect
Osteomalacia	Stem Tip Impingement
Osteopetrosis	Cementless Prosthesis
Osteogenesis Imperfecta
Thalassemia
Neuromuscular Disorder
Parkinsonism
Neuropathic Arthropathy
Poliomyelitis
Cerebral Palsy
Myasthenia Gravis
Seizures
Ataxia

Table 2.

Vancouver Classification of Postoperative Periprosthetic Femoral Fracture

Type and Subtype	Location and Characteristics
Type A	Trochanteric Region
A_G	Greater Trochanter
A_L	Lesser Trochanter
Type B	Around or just Distal to the Stem
B1	Stem Well Fixed
B2	Stem Loose
B3	Stem Loose, Poor Bone Stock
Type C	Well Below the Stem

Table 3.

Vancouver Classification of Intraoperative Periprosthetic Femoral Fracture

Type	Characteristics
Type A	Proximal Metaphysis, not Extending to Diaphysis
Type B	Diaphyseal, not Extending into Distal Diaphysis Distal Fractures Extending beyond the Longest
Type C	Extension of the Longest Revision Stem and can include Distal Metaphysis
		º Subtype1:CorticalPerforations
		º Subtype 2: Undisplaced Linear Crack
		º Subtype 3: Displaced or Unstable Fractures

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