MANAGEMENT OF TYPE B FEMORAL PERIPROSTHETIC FRACTURES USING A TAPERED, FLUTED AND DISTALLY FIXED STEM

Abstract

The management of periprosthetic femoral fractures around a total hip replacement can often be difficult and challenging; especially as they often occur in elderly patients with marked osteolysis and thin cortices.Various non-surgical and surgical treatment modalities have been described.

We reviewed 24 patients with type B fractures (Vancouver classification) managed with a cementless, tapered, fluted and distally fixed stem utilising a trans-femoral approach.There were 15 female and 9 male patients.The average age was 74 years.The average interval between the index operation and surgery was 10.8 years. The majority of the fractures occurred following trivial trauma. The average duration of the surgical procedure when both the cup and the stem were revised was 3 hours 14 minutes and 2 hours 14 minutes when only the stem was revised. The average operative blood loss was 1700 mls and 940 mls respectively. There were five dislocations. Three were managed conservatively without further problems. Two patients were treated surgically. There were two cases of nonunion one of which was secondary to infecton.

The average Harris hip score at follow-up was 69.The majority of the fractures united (91%). The average radiological subsidence was 5 mm post-operatively. Subsidence occurred within the first 6 months prior to fracture union with no further subsidence thereafter. Subsidence was notably absent in those patients in whom the fracture failed to unite. The majority of the patients showed a relatively good health status at follow-up.

This technique for the management of this difficult problem offers the advantage of providing a relatively short operative time with reduced patient morbidity.It allows early mobilization and the majority of the fractures unite uneventfully.

The biggest uncertainty surrounding this type of stem is the long-term survivorship in the younger patient.