Abstract
We evaluated thirty six patients who underwent revision total hip arthroplasty for Vancouver type B periprosthetic femoral fractures. The implant used was a modular proximal femoral replacement stem cemented distally. All the patients were treated at Wrightington Hospital and included 15 males and 21 females. The primary diagnosis was OA in 28, RA in 2, AVN following femoral neck fractures in 3 and hip dysplasia in 3. The average age of patients was 75 years.
The fractures and bone loss were classified according to the Vancouver classification and included 23 B2 and 13 B2 fractures. The mechanism of injury was minor fall in 24 patients, spontaneous in 8 and intraoperative injury in 4.
Using a trans-trochanteric approach the existing prosthesis was removed and a long stem modular femoral stem was inserted bypassing the area of proximal femoral fracture/bone loss. Patients were typically mobilised within the first post-operative week. The patients were clinically and radiologically followed up at regular intervals. Fracture healing with significant improvement in bone stock was noted in 17 patients under 6 months, 13 patients at 12 months and 6 patients at 18 months.
Our series show that use of distally cemented long stem proximal femoral replacement prosthesis allows restoration of proximal bone stock and fracture healing in patients where conventional prostheses cannot be used because of massive bone loss in the proximal femur. This special modular prosthesis bypasses the area of bone loss/periprosthetic fracture, thus avoiding the need for bone allograft or other major reconstructive surgery in elderly patients.
Editoral Secretary Mr Peter Howard. Correspondence should be addressed to BHS at the Royal College of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN.
