Management of periprosthetic fractures around the femoral stem after total hip arthroplasty tha represents a significant challenge and optimal treatment remains controversial. Periprosthetic fractures of the distal femur after total knee. In addition, intraoperative fractures often result from errors in surgical planning or technique. Periprosthetic fractures of the distal femur most commonly present as fragility fractures associated with relatively minor trauma. Handbook of fractures 5th edition pdf free download direct link. Fracture around this spacer is an uncommon complication that presents serious treatment challenges. Incidence risk factors patient evaluation classifications treatment complications 3. Pdf total hip arthroplasty periprosthetic femoral fractures. Retrograde intramedullary nailing for periprosthetic. This textbook accumulates the latest global knowledge on periprosthetic fractures, including all relevant anatomical regions, surgical pitfalls, complex cases, and a brand new comprehensive unified classification system, ucs on periprosthetic fractures, combining the original vancouver classification with the aoota fracture and dislocation classification.
Successful treatment of periprosthetic femur fractures, like all fractures, requires careful attention to understand the. Infection following total hip arthroplasty can be a devastating complication, often necessitating a 2stage surgery with the temporary placement of an antibiotic spacer. Periprosthetic fractures after total knee arthroplasty may occur in any part of the femur, tibia and patella, and the most common pattern involves the supracondylar area of the distal femur. As a devastating complication of total hip arthroplasty tha, periprosthetic fracture pf is not rare with the reported incidence from 0. Total hip arthroplasty periprosthetic femoral fractures. A 46yearold female sustained a periprosthetic acetabular fracture 1 month following a revision total hip arthroplasty tha procedure. Definition of periprosthetic fractures in the dictionary. In addition, periprosthetic femur fractures carry a significantly higher mortality risk than either hip or knee arthroplasty or operative fixation of native distal femur fractures.
Information and translations of periprosthetic fractures in the most comprehensive dictionary definitions resource on the web. Periprosthetic fracture management pdf free download. At present, the vancouver classification system for periprosthetic hip fractures is the most common classification. Periprosthetic fractures are becoming increasingly frequent due to aging population and growing number of total joint replacements involving joints different from hip and knee, such as shoulder and elbow. Given the increasing number of primary and revision arthroplasty cases performed, the prevalence of uncemented devices, the improvements in implant survivorship, and an active but aging patient population with attendant comorbidities such as osteoporosis, periprosthetic fractures are an increasingly common complication. Through a minimally invasive technique with indirect reduction, the fracture was reduced and fixed using a liss locking plate and screws. Delay in identification and appropriate definitive management of periprosthetic fractures is associated with high morbidity and mortality.
In accordance with that, the 30day, 6month and 1year mortality rates of patients with periprosthetic distal femur fractures were 8, 24, and 27%, respectively 4. Leino ok, lempainen l, virolainen p, sarimo j, polonen t, makela kt 2014 operative results of periprosthetic fractures of the distal femur in a single academic unit. Oct 25, 2017 periprosthetic fractures are becoming increasingly frequent due to aging population and growing number of total joint replacements involving joints different from hip and knee, such as shoulder and elbow. Supracondylar periprosthetic fractures frequently occur above a wellfixed prosthesis, and risk factors include anterior femoral cortical notching and use of the rotational constrained implant. At present, the vancouver classification system for periprosthetic hip fractures is the most common classification system used by orthopedic surgeons. To evaluate outcome in 20 patients treated for periprosthetic fractures after total knee arthroplasty tka. May 25, 2017 mennen plate fixation for the treatment of periprosthetic femoral fractures. Hear the authors discuss periprosthetic fracture management this textbook accumulates the latest global knowledge on periprosthetic fractures, including all relevant anatomical regions, surgical pitfalls, complex cases, and a brand new comprehensive unified classification system, ucs on periprosthetic fractures, combining the original vancouver classification with the aoota fracture and. Periprosthetic fractures, revision total hip arthroplasty, total hip. Periprosthetic humeral shaft fractures were classified by wright and cofield with type a fracture proximal to the stem tip, type b at the tip and extending distally, and type c fracture distal to the stem. These injuries are often complicated by osteopenia of the distal femur secondary to stress shielding or osteolysis. Successful treatment of periprosthetic femur fractures, like all fractures, requires careful attention to understand the fracture pattern nuances, identifying and executing a rational treatment approach, and providing an appropriate postoperative recovery protocol. Overall, malunion rates may be even higher than in fractures occurring without a tka but are more commonly due to valgus and extension deformities 24, 25, 26.
Pdf periprosthetic fractures pff are complex management. In 1999, rorabeck reported an incidence of supracondylar. Periprosthetic fractures of the hip and knee pdf this is an uptodate, comprehensive yet concise guide for orthopedic surgeons covering the salient points of anatomy and operative approaches to periprosthetic fractures of the hip and knee. As with supracondylar femur fractures occurring in the absence of a tka, imn fixation of periprosthetic fractures carries a risk for rotational, sagittal, and coronal malalignment. Periprosthetic acetabular fractures orthopedic trauma service. The important issues that guide management of periprosthetic fractures are the location and severity of the fracture, the quality of the bone, and the fixation of the implant 85, 86. Implants that are not well fixed to bone following a periprosthetic fracture will require revision of the implant and stabilization of the fracture with an intramedullary stem approximately two cortical.
Periprosthetic fractures of the femur after total hip replacement can present some unique challenges to the treating reconstructive orthopedic surgeon. Periprosthetic femoral fractures in the emergency department. Treatment may differ depending on fracture location, bone condition, implant stability, patient characteristics, and surgeon experience. Effective management of periprosthetic fractures of the distal femur requires knowledge of both fracture fixation techniques and. Understand a practical treatment approach for management. Periprosthetic femur fractures diagnostic and current. Helfet, md at the orthopedic trauma service of hospital for special surgery for definitive management of her periprosthetic acetabular fracture. Special techniques and products have been developed to address these fractures. Retrograde femoral nailing of periprosthetic fractures around. Periprosthetic hip fracture classification systems.
Basic principles apply to treating periprosthetic tibia. Fracture after total hip replacement orthoinfo aaos. Periprosthetic and periimplant fractures clinical presentation. Periprosthetic fractures of the hip and knee pdf libribook. Radiographs revealed a leftsided comminuted periprosthetic femur fracture proximal to the femoral component. Consequently, pf patients have higher mortality rates of 7.
Get the definitive, two volume guide on fracture treatment, written by the worlds top orthopaedic surgeons. Periprosthetic fractures involving the distal femur are increasing in prevalence most likely down to an aging population they occur after trivial trauma such as the case above 1. American academy of orthopedic surgeons aaos classification cooke and newman modified bethea classification johansson classification vancouver clas. Optimal indications for surgical repair versus revision arthroplasty and optimal postoperative weightbearing protocols remain uncertain. To ensure usersafety and faster downloads, we have uploaded this. The original placement of the implant may predispose to later fracture, the longterm presence of the device may change the structure of the bone and increase susceptibility to fracture, and the implant itself may interfere with healing or the placement of other fixation devices. The ucs has substantial interobserver reliability and near perfect intraobserver reliability when used for periprosthetic fractures in.
This textbook accumulates the latest global knowledge on periprosthetic fractures, including all relevant anatomical regions, surgical pitfalls, complex cases, and a brand new comprehensive unified classification system, ucs on periprosthetic fractures, combining the. Traditionally, these fractures are classified by their location and prosthesis integrity, with the most common location involving the supracondylar region. Low healing rate of periprosthetic fractures was observed for a and b1 type fractures 65% and 66. Surgery was performed in all six patients with periprosthetic femur fractures and for one with a nonperiprosthetic patellar fracture. Periprosthetic fractures after total knee arthroplasty. By icjr modern trends in joint replacement 2010 featuring david nazarian. Records of 14 women and 6 men aged 45 to 85 mean, 67 years who underwent operative n18 or conservative n2 treatment for periprosthetic fractures of the supracondylar femur n15, patella n3, and tibia n2 following. It is imperative that adequate and sufficient mechanical fixation be achieved in the.
The osseointegrated interface was radiographically stable in all 14 cases. Define periprosthetic hip fractures and understand the classification 2. Versatile solutions for periprosthetic and periarticular fractures periprosthetic fractures present unique challenges, such as how to gain fixation when the medullary canal is occupied. Periprosthetic supracondylar femoral fractures above a total knee replacement. The most commonly used classification for periprosthetic fractures of the distal femur was described by rorabeck and taylor level iv evidence.
Periprosthetic fractures after total hip arthroplasty can present a difficult challenge to the reconstructive surgeons. A periprosthetic fracture is a broken bone that occurs around the implants of a total hip replacement. Periprosthetic femur fractures diagnostic and current concepts. Supracondylar periprosthetic femoral fractures are generally clas. Periprosthetic fractures around tha orthopaedic trauma. Reported outcomes for patients with periprosthetic. Periprosthetic fractures of the hip and knee surgical. Higher following revision arthroplasty as opposed to primary implantations. Fractures around implants pose unique fixation challenges. Dec 01, 2016 periprosthetic fractures are the third most common reason for revision total hip arthroplasty.
Apr 24, 2020 most late cases of periprosthetic fracture are associated with problems that are evident on xray films but have been ignored or neglected. Periprosthetic femur fractures orthopedic trauma service. Synthes offers versatile solutions for treatment of periprosthetic fractures. Treatment for periprosthetic tibia fractures should be based on the type of fracture and how it relates to the component, according to information presented at the 2010 annual meeting of the. A comprehensive yet concise book discussing surgical approaches for periprosthetic fractures of the hip and knee, covering history, classification and evaluation, and surgical approaches to the acetabulum, proximal femur, distal femur, tibia, and interprosthetic fractures. Periprosthetic fractures of the femur associated with hip. Periprosthetic femoral fractures above total knee replacements. Periprosthetic fracture after total hip arthroplasty pdf free. A ct scan was performed and the femoral component was determined to be stable. Our manuscript details the successful surgical treatment of a previously unreported fracture around an antibiotic spacer.
Periprosthetic fractures of hip, this video lecture presents by dr. Periprosthetic fractures around total hip arthroplasty with a stable. Jan 31, 2019 periprosthetic fractures occur significantly closer to the prosthesis leaving less room for fracture fixation in patients with anterior notching than in patients without notching. Marwin, journalbulletin of the hospital for joint disease, year20. Jan 31, 2019 fractures around implants pose unique fixation challenges.
Supracondylar periprosthetic femoral fractures are generally classified via the rorabeck and taylor system where 2. Unlike most other fractures, modification of standard techniques is often required to obtain a stable fixation. Occurring most often in older patients with multiple medical conditions, they require surgical expertise. Pdf periprosthetic femoral fractures around hip arthroplasty. Shekhar agarwal, chief orthopedic surgeon, delhi institute of trauma and orthopedics, delhi to know more information, kindly. Periprosthetic fractures around the knee linkedin slideshare.
Sep 18, 2014 periprosthetic fractures around the knee 1. Periprosthetic fractures around tha whenhow to fix, when to revise. Periprosthetic acetabular fractures orthopedic trauma. Rockwood and greens fractures in adults 8th edition 2 volume set pdf free download direct link need the goto reference on adult bone and joint injuries. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. Periprosthetic fractures are rare and are usually related to trauma or, less frequently, occur intraoperatively. Nov 20, 20 periprosthetic fractures occur around total joint replacements and are difficult to treat. Periprosthetic fractures of the hip and knee surgical techniques. The most common treatment paradigm involves treating fractures around a wellfixed stem with osteosynthesis, whereas fractures around a loose stem require revision. Basic principles apply to treating periprosthetic tibia fractures.
Mennen plate fixation for the treatment of periprosthetic femoral fractures. These types of fractures are most often the result of a fall. In this article, we are sharing with our audience the genuine pdf download of handbook of fractures 5th edition pdf using direct links which can be found at the end of this blog post. Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Periprosthetic fractures of the distal femur after total. Retrograde femoral nailing of periprosthetic fractures. Periprosthetic fracture an overview sciencedirect topics. Periprosthetic fractures occur around total joint replacements and are difficult to treat.
Jun 30, 2009 all periprosthetic fractures occurred in patients with distal femoral implants 6154, 3. Our manuscript details the successful surgical treatment of a previously unreported fracture around an antibiotic. Distal femoral periprosthetic fracture radiology case. It is a serious complication that most often requires surgery. Apr 19, 2014 periprosthetic fractures of hip, this video lecture presents by dr. Fore 2016 2nd biennial arthroplasty disaster international conference. The latter is due to the greater broaching force that may be required to achieve a stable boneimplant interface and initial implant stability. During primary tha, intraoperative periprosthetic fractures have been reported to occur in 0.