INTRODUCTION: The present study compares the outcome of the long cemented stem and the revision uncemented stem used in periprosthetic femoral fractures. We propose that the revision with a long stem cemented prosthesis does not compromise fracture healing. PATIENTS AND METHODS: A consecutive series of 37 patients, operated between 2010 and 2017, were enrolled in a retrospective analysis. A long cemented stem was implanted in 21 patients (study group; age at operation: 63 to 89 years). A distally tapered fluted uncemented stem was used in 16 patients (control group; age at operation: 35 to 77 years). The clinical outcome was evaluated with Merle d'Aubigné and Postel scoring system. Standard radiographs were taken before surgery, at 3, 6, and 12 months postoperatively, and last follow-up. Any and all complications during the follow-up period were recorded. RESULTS: Although a significant difference (P = 0.006) was observed in the post-operative Merle d´Aubigné score over the 12-month follow-up period, no significant difference (P = 0.066) was found in the post-operative pain score between the study and control groups. Periodic radiographic assessments showed the disappearance of radiolucent lines and the diaphyseal part of the fracture was healed in all 34 followed-up cases during the first annual follow-up. Early surgical complications were seen in both groups, the medical complications were observed only in the study group. CONCLUSION: Based on our results, periprosthetic fractures of the femur after a total hip arthroplasty were associated with significant morbidity and increased mortality in elderly patients. Revision with a long-stem cemented prosthesis provided early pain-free weight-bearing without compromising the healing of femoral fractures in elderly patients with osteoporotic bone, altered mobility, poor balance, and reduced cognitive capacity.

Charles University Faculty of Medicine in Hradec Králové Hradec Králové Czech Republic

Department of Medical Biophysics Charles University Prague Faculty of Medicine in Hradec Králové Hradec Králové Czech Republic

Department of Orthopedic Surgery University Hospital in Hradec Králové Hradec Králové Czech Republic

Zobrazit více v PubMed

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;89:780–785. doi:10.2106/00004623-200704000-00012 PubMed DOI

Korbel M, Sponer P, Kucera T, Procházka E, Procek T. Results of treatment of periprosthetic femoral fractures after total hip arthroplasty. Acta Med. 2013;56:67–72. doi:10.14712/18059694.2014.26 PubMed DOI

Märdian S, Perka C, Schaser KD, Gruner J, Scheel F, Schwabe P. Cardiac disease and advanced age increase the mortality risk following surgery for periprosthetic femoral fractures. Bone Joint J. 2017;99-B:921–926. doi:10.1302/0301-620X.99B7.BJJ-2016-0974.R1 PubMed DOI

Corten K, Macdonald SJ, McCalden RW, Bourne RB, Naudie DD. Results of cemented femoral revisions for periprosthetic femoral fractures in the elderly. J Arthroplasty. 2012;27:220–225. doi:10.1016/j.arth.2011.03.050 PubMed DOI

Haasper C, Enayatollahi MA, Gehrke T. Treatment of Vancouver type B2 periprosthetic femoral fractures. Int Orthop. 2015;39:1989–1993. doi:10.1007/s00264-015-2959-4 PubMed DOI

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;85-A:2156–2162. doi:10.2106/00004623-200311000-00015 PubMed DOI

Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg Br. 1972;54:61–76. doi:10.1302/0301-620X.54B1.61 PubMed DOI

Pedersen TJ, Lauritsen JM. Routine functional assessment for hip fracture patients: are there sufficient predictive properties for subgroup identification in treatment and rehabilitation? Acta Orthop. 2016;87:374–379. doi:10.1080/17453674.2016.1197534 PubMed DOI PMC

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

Tsiridis E, Pavlou G, Venkatesh R, Bobak P, Gie G. Periprosthetic femoral fractures around hip arthroplasty: current concepts in their management. Hip Int. 2009;19:75–86. doi:10.1177/112070000901900201 PubMed DOI

Duncan CP, Haddad FS. The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J. 2014;96-B:713–716. doi:10.1302/0301-620X.96B6.34040 PubMed DOI

Munro JT, Garbuz DS, Masri BA, Duncan CP. Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures. Clin Orthop Relat Res. 2014;472:590–598. doi:10.1007/s11999-013-3087-3 PubMed DOI PMC

Khan T, Grindlay D, Ollivere BJ, Scammell BE, Manktelow AR, Pearson RG. A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Joint J. 2017;99-B:17–25. doi:10.1302/0301-620X.99B4.BJJ-2016-1311.R1 PubMed DOI

Hevesi M, Wyles CC, Yao JJ, et al. Revision total hip arthroplasty for the treatment of fracture: more expensive, more complications, same diagnosis-related groups: a local and national cohort study. J Bone Joint Surg Am. 2019;101:912–919. doi:10.2106/JBJS.18.00523 PubMed DOI

Crockarell JR, Berry DJ, Lewallen DG. Nonunion after periprosthetic femoral fracture associated with total hip arthroplasty. J Bone Joint Surg Am. 1999;81:1073–1079. doi:10.2106/00004623-199908000-00003 PubMed DOI

Garland A, Gordon M, Garellick G, Kärrholm J, Sköldenberg O, Hailer NP. Risk of early mortality after cemented compared with cementless total hip arthroplasty: a nationwide matched cohort study. Bone Joint J. 2017;99-B:37–43. doi:10.1302/0301-620X.99B1.BJJ-2016-0304.R1 PubMed DOI

Young SW, Walker CG, Pitto RP. Functional outcome of femoral periprosthetic fracture and revision hip arthroplasty: a matched–pair study from the New Zealand Registry. Acta Orthop. 2008;79:483–488. doi:10.1080/17453670710015463 PubMed DOI

Yao JJ, Maradit Kremers H, Abdel MP, et al. Long-term mortality after revision THA. Clin Orthop Relat Res. 2018;476(2):420–426. doi:10.1007/s11999.0000000000000030 PubMed DOI PMC

Gibbs VN, McCulloch RA, Dhiman P, et al. Modifiable risk factors for mortality in revision total hip arthroplasty for periprosthetic fracture. Bone Joint J. 2020;102-B:580–585. doi:10.1302/0301-620X.102B5.BJJ-2019-1673.R1 PubMed DOI

Köksal A, Öner A, Çimen O, et al. Femoral stem fractures after primary and revision hip replacements: a single-center experience. J Dis Relat Surg. 2020;31(3):557–563. PubMed PMC

Çağlar Ö, Tokgözoğlu M, Akgün RC, Atilla B. Low-dose vancomycin-loaded cement spacer for two-stage revision of infected total hip arthroplasty. J Dis Relat Surg. 2020;31(3):449–455. PubMed PMC

Khan T, Middleton R, Alvand A, Manktelow ARJ, Scammell BE, Ollivere BJ. High mortality following revision hip arthroplasty for periprosthetic femoral fracture. Bone Joint J. 2020;102-B:1670–1674. doi:10.1302/0301-620X.102B12.BJJ-2020-0367.R1 PubMed DOI

Ramavath A, Lamb JN, Palan J, Pandit HG, Jain S. Postoperative periprosthetic femoral fracture around total hip replacements: current concepts and clinical outcomes. EFORT Open Rev. 2020;5(9):558–567. doi:10.1302/2058-5241.5.200003 PubMed DOI PMC

Boronratwet P, Fu MC, Adrados M, et al. Unlike native hip fractures, delay to periprosthetic hip fracture stabilization does not significantly affect most short-term perioperative outcomes. J Arthroplasty. 2019;34:564–569. doi:10.1016/j.arth.2018.11.006 PubMed DOI

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 Arthroplasty. 2005;20:751–756. doi:10.1016/j.arth.2004.11.020 PubMed DOI