Skip to main content
SpringerLink
Log in

Periprosthetic Femur Fractures Around Total Hip Arthroplasty with a Loose Component

  • Chapter
  • First Online:
Periprosthetic Fractures of the Hip and Knee

  • 812 Accesses

Abstract

Periprosthetic hip fractures following total hip arthroplasty pose a challenge to both arthroplasty and trauma surgeons alike. One critical component in the evaluation of a patient with a periprosthetic hip fracture is determination of stem stability. Failure to examine the stem may result in an incorrect treatment algorithm and early catastrophic failure of the implant construct. In 2017, this is becoming a larger issue as demand for revision total hip arthroplasty (THA) increases. Several factors contribute to the type of implant used for fixation of these fractures and depends on age, activity level, comorbidities, and available bone stock. Stem stability, that is, whether a stem is stable or loose, also helps dictate implant requirements. The purpose of this chapter is to review the evaluation and management of periprosthetic hip fractures around a loose stem and offer intraoperative tips and tricks for success.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Berry DJ. Epidemiology: hip and knee. Orthop Clin North Am. 1999;30(2):183–90.

    Article  CAS  Google Scholar 

  2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–5.

    PubMed  Google Scholar 

  3. Haddad FS. Periprosthetic femoral fractures: a window into some of the challenges we face. Bone Joint J. 2016;98B(4):433–4.

    Article  Google Scholar 

  4. Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007;38(6):651–4.

    Article  Google Scholar 

  5. Moreta J, Aguirre U, de Ugarte OS, Jauregui I, Mozos JL. Functional and radiological outcome of periprosthetic femoral fractures after hip arthroplasty. Injury. 2015;46(2):292–8.

    Article  Google Scholar 

  6. Ricci WM. Periprosthetic femur fractures. J Orthop Trauma. 2015;29(3):130–7.

    Article  Google Scholar 

  7. Macdonald SJ, Paprosky WG, Jablonsky WS, Magnus RG. Periprosthetic femoral fractures treated with a long-stem cementless component. J Arthroplast. 2001;16(3):379–83.

    Article  CAS  Google Scholar 

  8. Bethea JS, DeAndrade JR, Fleming LL, Lindenbaum SD, Welch RB. Proximal femoral fractures following total hip arthroplasty. Clin Orthop Relat Res. 1982;170:95–106.

    Google Scholar 

  9. Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect. 1995;44:293–304.

    CAS  PubMed  Google Scholar 

  10. Bhattacharyya T, Chang D, Meigs JB, Estok DM, Malchau H. Mortality after periprosthetic fracture of the femur. J Bone Joint Surg Am. 2007;89(12):2658–62.

    Article  Google Scholar 

  11. Carli AV, Negus JJ, Haddad FS. Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture? Bone Joint J. 2017;99B(1 Supple A):50–9.

    Article  Google Scholar 

  12. Marsland D, Mears SC. A Review of Periprosthetic Femoral Fractures Associated With Total Hip Arthroplasty. Geriatr Orthop Surg Rehabil. 2012;3(3):107–20.

    Article  Google Scholar 

  13. Shah RP, Sheth NP, Gray C, Alosh H, Garino JP. Periprosthetic Fractures Around Loose Femoral Components. J Am Acad Orthop Surg. 2014;22(8):482–90.

    Article  Google Scholar 

  14. Streit MR, Merle C, Clarius M, Aldinger PR. Late periprosthetic femoral fracture as a major mode of failure in uncemented primary hip replacement. J Bone Joint Surg Br. 2011;93(2):178–83.

    Article  CAS  Google Scholar 

  15. Cook RE, Jenkins PJ, Walmsley PJ, Patton JT, Robinson CM. Risk factors for periprosthetic fractures of the hip: a survivorship analysis. Clin Orthop Relat Res. 2008;466(7):1652–6.

    Article  CAS  Google Scholar 

  16. Meek RM, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br. 2011;93(1):96–101.

    Article  CAS  Google Scholar 

  17. Singh JA, Jensen MR, Harmsen SW, Lewallen DG. Are gender, comorbidity, and obesity risk factors for postoperative periprosthetic fractures after primary total hip arthroplasty? J Arthroplast. 2013;28(1):126–31.

    Article  Google Scholar 

  18. Harris B, Owen JR, Wayne JS, Jiranek WA. Does femoral component loosening predispose to femoral fracture? An in vitro comparison of cemented hips. Clin Orthop Relat Res. 2010;468(2):497–503.

    Article  Google Scholar 

  19. Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplast. 2005;20(7):857–65.

    Article  Google Scholar 

  20. Beals RK, Tower SS. Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res. 1996;327:238–46.

    Article  Google Scholar 

  21. Thien TM, Chatziagorou G, Garellick G, Furnes O, Havelin LI, Mäkelä K, et al. Periprosthetic femoral fracture within two years after total hip replacement: analysis of 437,629 operations in the Nordic Arthroplasty Register Association database. J Bone Joint Surg Am. 2014;96(19):e167.

    Article  Google Scholar 

  22. Abdel MP, Houdek MT, Watts CD, Lewallen DG, Berry DJ. Epidemiology of periprosthetic femoral fractures in 5417 revision total hip arthroplasties: a 40 year experience. Bone Joint J. 2016;98B(4):468–74.

    Article  Google Scholar 

  23. Ghanem E, Houssock C, Pulido L, Han S, Jaberi FM, Parvizi J. Determining “true” leukocytosis in bloody joint aspiration. J Arthroplast. 2008;23(2):182–7.

    Article  Google Scholar 

  24. Pike J, Davidson D, Garbuz D, Duncan CP, O’Brien PJ, Masri BA. Principles of treatment for periprosthetic femoral shaft fractures around well-fixed total hip arthroplasty. J Am Acad Orthop Surg. 2009;17(11):677–88.

    Article  Google Scholar 

  25. Chevillotte CJ, Ali MH, Trousdale RT, Larson DR, Gullerud RE, Berry DJ. Inflammatory laboratory markers in periprosthetic hip fractures. J Arthroplast. 2009;24(5):722–7.

    Article  Google Scholar 

  26. George J, Kwiecien G, Klika AK, Ramanathan D, Bauer TW, Barsoum WK, et al. Are Frozen Sections and MSIS Criteria Reliable at the Time of Reimplantation of Two-stage Revision Arthroplasty? Clin Orthop Relat Res. 2016;474(7):1619–26.

    Article  Google Scholar 

  27. Kwiecien G, George J, Klika AK, Zhang Y, Bauer TW, Rueda CA. Intraoperative frozen section histology: matched for musculoskeletal infection society criteria. J Arthroplast. 2017;32(1):223–7.

    Article  Google Scholar 

  28. O’Shea K, Quinlan JF, Kutty S, Mulcahy D, Brady OH. The use of uncemented extensively porous-coated femoral components in the management of Vancouver B2 and B3 periprosthetic femoral fractures. J Bone Joint Surg Br. 2005;87(12):1617–21.

    Article  Google Scholar 

  29. Sheth NP, Brown NM, Moric M, Berger RA, DellaValle CJ. Operative treatment of early peri-prosthetic femur fractures following primary total hip arthroplasty. J Arthroplast. 2013;28(2):286–91.

    Article  Google Scholar 

  30. Kim Y, Tanaka C, Tada H, Kanoe H, Shirai T. Treatment of periprosthetic femoral fractures after femoral revision using a long stem. BMC Musculoskelet Disord. 2015;16:113.

    Article  Google Scholar 

  31. Brady OH, Garbuz DS, Masri BA, Duncan CP. The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplast. 2000;15(1):59–62.

    Article  CAS  Google Scholar 

  32. Naqvi GA, Baig SA, Awan N. Interobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty. J Arthroplast. 2012;27(6):1047–50.

    Article  Google Scholar 

  33. Haidar SG, Goodwin MI. Dynamic compression plate fixation for post-operative fractures around the tip of a hip prosthesis. Injury. 2005;36(3):417–23.

    Article  CAS  Google Scholar 

  34. Corten K, Vanrykel F, Bellemans J, Frederix PR, Simon JP, Broos PL. An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component. J Bone Joint Surg Br. 2009;91(11):1424–30.

    Article  CAS  Google Scholar 

  35. Lindahl H, Garellick G, Regnér H, Herberts P, Malchau H. Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am. 2006;88(6):1215–22.

    Article  Google Scholar 

  36. Canbora K, Kose O, Polat A, Aykanat F, Gorgec M. Management of Vancouver type B2 and B3 femoral periprosthetic fractures using an uncemented extensively porous-coated long femoral stem prosthesis. Eur J Orthop Surg Traumatol. 2013;23(5):545–52.

    Article  Google Scholar 

  37. Levine BR, DellaValle CJ, Lewis P, Berger RA, Sporer SM, Paprosky W. Extended trochanteric osteotomy for the treatment of vancouver B2/B3 periprosthetic fractures of the femur. J Arthroplast. 2008;23(4):527–33.

    Article  Google Scholar 

  38. Mulay S, Hassan T, Birtwistle S, Power R. Management of types B2 and B3 femoral periprosthetic fractures by a tapered, fluted, and distally fixed stem. J Arthroplast. 2005;20(6):751–6.

    Article  Google Scholar 

  39. Anakwe RE, Aitken SA, Khan LA. Osteoporotic periprosthetic fractures of the femur in elderly patients: outcome after fixation with the LISS plate. Injury. 2008;39(10):1191–7.

    Article  CAS  Google Scholar 

  40. Neumann D, Thaler C, Dorn U. Management of Vancouver B2 and B3 femoral periprosthetic fractures using a modular cementless stem without allografting. Int Orthop. 2012;36(5):1045–50.

    Article  Google Scholar 

  41. Moran MC. Treatment of periprosthetic fractures around total hip arthroplasty with an extensively coated femoral component. J Arthroplast. 1996;11(8):981–8.

    Article  CAS  Google Scholar 

  42. García-Rey E, García-Cimbrelo E, Cruz-Pardos A, Madero R. Increase of cortical bone after a cementless long stem in periprosthetic fractures. Clin Orthop Relat Res. 2013;471(12):3912–21.

    Article  Google Scholar 

  43. Brem MH, Bail HJ, Biber R. Value of incisional negative pressure wound therapy in orthopaedic surgery. Int Wound J. 2014;11(Suppl 1):3–5.

    Article  Google Scholar 

  44. Ricci WM, Bolhofner BR, Loftus T, Cox C, Mitchell S, Borrelli J. Indirect reduction and plate fixation, without grafting, for periprosthetic femoral shaft fractures about a stable intramedullary implant. Surgical technique. J Bone Joint Surg Am. 2006;88(Suppl 1 Pt 2):275–82.

    Article  Google Scholar 

  45. Wood GC, Naudie DR, McAuley J, McCalden RW. Locking compression plates for the treatment of periprosthetic femoral fractures around well-fixed total hip and knee implants. J Arthroplast. 2011;26(6):886–92.

    Article  Google Scholar 

  46. Lewis GS, Caroom CT, Wee H, Jurgensmeier D, Rothermel SD. Tangential bicortical locked fixation improves stability in Vancouver B1 Periprosthetic Femur Fractures: a biomechanical study. J Orthop Trauma. 2015;29(10):364–70.

    Article  Google Scholar 

  47. Springer BD, Berry DJ, Lewallen DG. Treatment of periprosthetic femoral fractures following total hip arthroplasty with femoral component revision. J Bone Joint Surg Am. 2003;85A(11):2156–62.

    Article  Google Scholar 

  48. Weber M, Hempfing A, Orler R, Ganz R. Femoral revision using the Wagner stem: results at 2–9 years. Int Orthop. 2002;26(1):36–9.

    Article  CAS  Google Scholar 

  49. Warren PJ, Thompson P, Flechter MD. Transfemoral implantation of the Wagner SL stem. The abolition of subsidence and enhancement of osteotomy union rate using Dall-Miles cables. Arch Orthop Trauma Surg. 2002;122(9–10):557–60.

    Article  CAS  Google Scholar 

  50. Fink B, Grossmann A, Singer J. Hip revision arthroplasty in periprosthetic fractures of Vancouver type B2 and B3. J Orthop Trauma. 2012;26(4):206–11.

    Article  Google Scholar 

  51. Abdel MP, Lewallen DG, Berry DJ. Periprosthetic femur fractures treated with modular fluted, tapered stems. Clin Orthop Relat Res. 2014;472(2):599–603.

    Article  Google Scholar 

  52. Park MS, Lim YJ, Chung WC, Ham DH, Lee SH. Management of periprosthetic femur fractures treated with distal fixation using a modular femoral stem using an anterolateral approach. J Arthroplast. 2009;24(8):1270–6.

    Article  Google Scholar 

  53. Fink B, Fuerst M, Singer J. Periprosthetic fractures of the femur associated with hip arthroplasty. Arch Orthop Trauma Surg. 2005;125(7):433–42.

    Article  Google Scholar 

  54. Mertl P, Philippot R, Rosset P, Migaud H, Tabutin J, Velde D. Distal locking stem for revision femoral loosening and periprosthetic fractures. Int Orthop. 2011;35(2):275–82.

    Article  Google Scholar 

  55. Learmonth ID. The management of periprosthetic fractures around the femoral stem. J Bone Joint Surg Br. 2004;86(1):13–9.

    Article  CAS  Google Scholar 

  56. Youssef B, Pavlou G, Shah N, Macheras G, Tsiridis E. Impaction bone grafting for periprosthetic fractures around a total hip arthroplasty. Injury. 2014;45(11):1674–80.

    Article  Google Scholar 

  57. Lee GC, Nelson CL, Virmani S, Manikonda K, Israelite CL, Garino JP. Management of periprosthetic femur fractures with severe bone loss using impaction bone grafting technique. J Arthroplast. 2010;25(3):405–9.

    Article  Google Scholar 

  58. Fetzer GB, Callaghan JJ, Templeton JE, Goetz DD, Sullivan PM, Johnston RC. Impaction allografting with cement for extensive femoral bone loss in revision hip surgery: a 4 to 8 year follow up study. J Arthroplast. 2001;16(8 Suppl 1):195–202.

    Article  CAS  Google Scholar 

  59. Tsiridis E, Narvani AA, Haddad FS, Timperley JA, Gie GA. Impaction femoral grafting and cemented revision for periprosthetic femoral fractures. J Bone Joint Surg Br. 2003;86(8):1124–32.

    Article  Google Scholar 

  60. Rassouli MR, Porat MD, Hozack WJ, Parvizi J. Proximal femoral replacement and allograft prosthesis composite in the treatment of periprosthetic fractures with significant proximal bone loss. J Orthop Surg. 2012;4(4):203–10.

    Article  Google Scholar 

  61. Kellett CF, Boscainos PJ, Maury AC, Pressman A, Cayen B, Zalzal P, et al. Proximal femoral allograft treatment of Vancouver type-B3 periprosthetic femoral fractures after total hip arthroplasty. Surgical technique. J Bone Joint Surg Am. 2007;89(Suppl 2 Pt 1):S68–79.

    Article  Google Scholar 

  62. Babis GC, Sakellariou VI, O'Connor MI, Hanssen AD, Sim FH. Proximal femoral allograft-prosthesis composites in revision hip replacement: a 12-year follow-up study. J Bone Joint Surg Br. 2010;92(3):349–55.

    Article  CAS  Google Scholar 

  63. Wang JW, Wang CJ. Proximal femoral allografts for bone deficiencies in revision hip arthroplasty: a medium-term follow-up study. J Arthroplast. 2004;19(7):845–52.

    Article  Google Scholar 

  64. Parvizi J, Sim FH. Proximal femoral replacements with megaprostheses. Clin Orthop Relat Res. 2004;420:169–75.

    Article  Google Scholar 

  65. McLean AL, Patton JT, Moran M. Femoral replacement for salvage of periprosthetic fracture around a total hip replacement. Injury. 2012;43(7):1166–9.

    Article  Google Scholar 

  66. Klein GR, Parvizi J, Rapuri V, Wolf CF, Hozack WJ, Sharkey PF, et al. Proximal femoral replacement for the treatment of periprosthetic fractures. J Bone Joint Surg Am. 2005;87(8):1777–81.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Joshua Rozell & Derek J. Donegan

Authors
  1. Joshua Rozell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Derek J. Donegan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joshua Rozell .

Editor information

Editors and Affiliations

  1. Division of Orthopedic Trauma and Adult Reconstruction, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA

    Frank A. Liporace

  2. Division of Orthopedic Trauma and Adult Reconstruction, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA

    Richard S. Yoon

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Rozell, J., Donegan, D.J. (2019). Periprosthetic Femur Fractures Around Total Hip Arthroplasty with a Loose Component. In: Liporace, F., Yoon, R. (eds) Periprosthetic Fractures of the Hip and Knee. Springer, Cham. https://doi.org/10.1007/978-3-319-43008-9_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43008-9_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43007-2

  • Online ISBN: 978-3-319-43008-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation