Periprosthetic Femoral Fractures Associated with Total Hip Replacement

Introduction: The incidence of periprosthetic femoral fractures increases by year due to the increasing number of primary and revision total hip replacement (THR) procedures. About 200 revision surgeries yearly are performed in Hospital of Traumatology and Orthopaedics (HTO), where most of revisions are performed in Latvia. The aim of this study is to evaluate the periprosthetic fractures associated with THR, reasons, severity and treatment options.

Materials and methods: Retrospective analysis of hospital case-records of two groups of patients, treated in HTO from 2009 till 2010 and from 2014 till 2015 was performed. The study included all individuals who underwent revision surgery in the HTO due to periprosthetic femoral fractures. The patient’s functional assessment, and radiological examination were included in the evaluation. The Vancouver classification of periprosthetic femoral fractures was used.

Results: The first group included 27 patients (15 females, 12 males, age range 39-99, mean age 70 years); the second group included 29 patients (13 females, 16 males, age range 39-85, mean age 71 years) with periprosthetic femoral fractures. According to the Vancouver classification there were 2 type A_L, 5 type B₁, 8 type B₂, 6 type B₃ and 6 type C fractures in the first group; 5 type A_L, 5 type A_G, 7 type B₁, 4 type B₂, 3 type B₃ and 5 type C fractures in the second group. In the first group patients underwent dynamic compression plating, revision endoprosthesis and cable wiring or the combination of those methods. Angled stable plating was added as a treatment option in the second group of patients.

Conclusions and discussion: Study shows similar number of periprosthetic femoral fractures treated with THR in HTO during 2-year periods in last 7 years. The study highlights the growth of patients with type A_G, A_L fractures. Further studies are recommended for deeper investigation of these reasons. We suggest that improvement of osteosynthesis possibilities with angled stable plating should be evaluated.