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General Orthopaedics


Current Concepts in Joint Replacement (CCJR) – Spring 2015


The Vancouver classification separates periprosthetic femur fractures after THA into three regions (A - trochanteric, B - around or just below the stem, and C - well below the stem), with fractures around or just below the stem further separated into those with a well-fixed (B1) or loose stem and good (B2) or poor (B3) bone stock. Trochanteric fractures may be associated with osteolysis and require treatment that addresses osteolysis as well as ORIF of displaced fractures. Fractures around a well-fixed stem can be treated with ORIF using cerclage or cable plating, while those around a loose stem require implant revision usually to a longer cementless tapered or distally porous coated cementless stem. Fractures around a loose stem with poor bone stock in which salvage of the proximal femur is not possible require replacement of the proximal femur with an allograft prosthetic composite or proximal femoral replacement. Fractures well below the stem can be treated with conventional plating methods.

Periprosthetic acetabular fractures are rare and usually occur in the early post-operative period or late as a result of osteolysis or trauma. These can generally be separated into those with a stable acetabular component which can be treated non-operatively, and those with an unstable component often with discontinuity or posterior column instability which require complex acetabular reconstruction utilizing plating or revision to a cup-cage.