Background: Periprosthetic fractures are now recognised as the second most frequent reason for revision following total hip replacement, less so than aseptic loosening but more so than dislocation and infection. The post-operative incidence of peri-prosthetic fracture is approximately 1% after primary arthroplasty and 4% after revision surgery. 75% of postoperative femoral fractures are associated with prosthetic loosening. The Vancouver system, a reliable and valid classification scheme, sub-classifies fractures around the stem of the prosthesis into three types. B2 is where there is a loose implant but adequate bone stock and B3 is where the implant is loose and bone stock is deficient.

Aim: To assess the outcome of patients with Vancouver type B2 and B3 fractures treated with femoral revision using an uncemented extensively porous coated implant (Solution ® stem).

Methods: A retrospective chart review was performed. Patients in addition attended for a clinical and radiographic assessment. Engh’s criteria for osseointegration of cementless components and the length of time to fracture union were the radiographic endpoints. The Harris hip score was used for clinical assessment with a score of above 80 indicating a satisfactory result.

Results: From July 1999 to present, we identified 22 such patients treated with this method. The mean duration of follow-up was 33.7 months with a minimum of 12 months. The mean age of patients was 78.7 years (range 67–88). The mean time from the index procedure to fracture was 10.8 years (range 7–20 years). The index procedure was a primary total hip replacement in all but 2 cases (revisions). 18 patients had a good result. Four patients had a poor result. The mean Harris Hip Score in the 18 patients was with good results was 82.7 and 69 in those with poor results. The mean duration to fracture union was 5.2 months (range 4–8 months). 17 patients needed concomitant acetabular cup revision. No patient showed any evidence of loosening or subsidence. 2 patients presented with deep seated infection (1 early, 1 late).

Conclusion: Periprosthetic fractures in the setting of a loose prosthesis present a difficult reconstructive challenge. Uncemented extensively porous coated femoral implants incorporate distal with intramedullary fixation of most fractures, permitting fracture healing as well as achieving osseointegration. We report good early survival rates, stable fixation and a low incidence of non union using this implant.

Background: CT scanning is an essential part of the preoperative planning process prior to surgical fixation of acetabular fractures. Considerable disparity exists between the clinical and radiological outcome following open reduction and internal fixation of these fractures. It is suggested that this disparity is due to poor assessment of the quality of reduction using plain radiographs alone.

Aim: To investigate the role of post-operative CT scanning following ORIF of acetabular fractures.

Methods: Prospective study commenced in January 2000 of all patients in our institution undergoing internal fixation of acetabular fractures. Post operative axial CT scans were compared with plain radiographs (AP pelvis and 45 degree oblique Judet views) with regard to the sensitivity to detect articular fracture reduction in terms of gap displacement and step deformity or offset. A simplified binary measurement of radiological outcome was used stratifying radiological result into anatomical and non-anatomical. Three observers independently reviewed the plain radiographs and CT scans at two separate time points and categorized the radiographic outcome as described. The interobserver reproducibility and intraobserver reliability of these measurements was expressed as a kappa statistic. In addition in those patients greater than 18 months following surgery we attempted to correlate the radiographic with the clinical outcome using the Harris hip score and the SF-36 score.

Results: 20 patients were recruited. Plain films were equieffective in detecting post-operative articular fragment displacement (p=0.24). The interobserver and intraobserver agreement between the radiological outcome measurements were good with respective kappa values of 0.61 and 0.65. There was a weak association between clinical and radiographic outcome as ascribed by post operative CT scans.

Conclusion: While there may be an argument for the use of post operative CT scanning acetabular fractures in selective cases, we did not find any significant benefit of CT scans over plain radiographs in the assessment of reduction or radiological outcome following these injuries. Hence we do not routinely advocate their use in the post operative setting.