Surgical treatment of periprosthetic femoral fractures following hip arthroplasty: Our institutional experience

Abstract Purpose Periprosthetic fractures are one of the most serious complications after hip replacement. The aim of this retrospective study was to evaluate the clinical outcome of surgical treatment of periprosthetic femoral fractures following total hip arthroplasty using treatment algorithm of the Vancouver classification. Materials and methods Fifty six periprosthetic femoral fractures operated on during the period December 2004–September 2013 were followed-up retrospectively. There were 40 women and 16 men with mean age at the time of surgery 64.7 years (41–88 years). The mean follow-up for the group was 5 years (range, 1–10 years). Periprosthetic fractures were classified according to the Vancouver classification. The clinical evaluation was performed with the Harris hip score, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Short Form 8 (SF-8). Bone healing, implant survival, pain, function and complications were recorded. Bone healing and implant stability were evaluated clinically and on plain radiographs. Results Uneventful bone healing was achieved in 52 cases. In two fractures (one type B1, one type C) nonunion and plate failure occurred. Two cemented stems were revised for aseptic loosening 6.5 and 7 years after fracture fixation. Uncontrollable prosthesis infection and sepsis in a rheumatoid (immunocompromised) patient required disarticulation of the involved extremity. Discussion and conclusions Periprosthetic femoral fractures are difficult to treat and require complex treatment approach according to risk assessment, fracture type, implant stability, bone stock and medical status of the patient. Using a treatment protocol of the Vancouver classification we obtained satisfactory outcome.