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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 487 - 487
1 Sep 2012
Giesinger K Yates P Stoffel K Ebneter L Day R Kuster M
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Introduction. Periprosthetic femur fractures are a serious complication after hip replacement surgery. In an aging population these fractures are becoming more and more common. Open reduction and plate osteosynthesis is one of the available treatment options. Objective. To investigate hip stem stability and cement mantle integrity under cyclic loading conditions after plate fixation with screws perforating the cement in the proximal fragment. Methods. Polished tapered hip stems were implanted in 16 biomechanical testing femora with Palacos cement (3rd generation technique) according to the manufacturer's recommendations. 8 testing bones were osteotomised distal to the stem representing the fracture group (Vancouver Type C). The osteotomy was fixed with a polyaxial locking plate, the other 8 specimens served as a control group. The specimens were tested in a biaxial material testing machine under axial compression (including adduction and torsion moments) for 100.000 cycles at physiological loads. Stem subsidence was measured in 3 planes with a stereoscopic image correlation system during the tests. Subsequently the sliced and crack dyed specimens were investigated microscopically for cement cracks. Results. In the control group no specimen failed during testing. There were no statistically significant differences in stem subsidence along the longitudinal axis (control group mean ± SD −15.4 ± 12.2 μm, fracture group −14.1 ± 13.1 μm). In the fracture group two specimens fractured through the most proximal screw hole after 74.000 and 80.000 cycles. Overall 15 out of 36 screws in the proximal fragment had direct stem contact. No cement cracks were detected in the sliced specimens in both groups. Conclusion. Drilling the cement mantle and placing screws in the cement did not increase stem subsidence under cyclic loading. No cracks or cement mantle failure were observed. Large screw diameters proximally weaken the lateral cortex resulting in tension failure of the bone. Plate fixation of a periprosthetic femoral fracture with a stable, cemented prosthesis does not lead to early cement mantle failure