Fracture of the femur in association with total hip arthroplasty is a challenging complication that has been well described. A variety of surgical treatment options have been reported. We present our experience of the Kent hip prosthesis in the management of periprosthetic femoral fractures.

We reviewed all patients (46) who had a Kent hip inserted for a periprosthetic femoral fracture. This group consisted of 16 males and 30 females of average age 73 years (43–96 years) at the time of fracture. Follow up ranged from 2 to 85 months (average, 4 years).

In 26 cases the primary prosthesis was a Charnley stem. Of the remaining cases the primary prostheses were as follows: 6 Austin Moore prostheses, 5 Howse, 4 Custom, 1 Exeter, 1 DHS, 1 Richards and 1 Thompson stem. There were 6 intraoperative fractures. Of the postoperative fractures forty-four were associated with a traumatic event. Time to fracture varied from 3 weeks to 20 years (average, 8 years). Prior to fracture 42 patients were living in their own home and 24 patients were mobile unaided. Twenty patients had pain prior to their fracture. The majority of patients were deemed ASA grade II or III. Thirty fractures were Johanssen type II, 14 type I, and 2 type III.

At the time of surgery, 32 patients had a loose stem and/or cup. Operating time was on average 143 minutes (range, 65–235 minutes) and intraoperative transfusion requirements ranged from 0–7 units of packed red cells (average, 3 units). Duration of hospital stay was on average 23 days (range, 7–77 days). Two patients developed superficial wound infections, six patients dislocated their prosthesis and one patient developed a chronic wound sinus.

In 34 cases fracture union was complete at latest review. Three patients required revision surgery for stem breakage and in 10 cases there was evidence of screw breakage.

At latest review, of the 31 patients that could be contacted 18 are still resident in their own homes. Twenty-six patients require the use of a walking aid (most commonly one stick). Ten patients have ongoing pain in relation to their operated hip.

In conclusion, we feel that the Kent hip prosthesis is a useful surgical option in the one-stage management of periprosthetic femoral fractures.

Recurrent posterior dislocation is a recognised complication following primary total hip arthroplasty. Incidences of between 0.11% and 4.5% have been reported in the literature.

Component revision is regarded as standard management of recurrent posterior dislocation. However, revision surgery is a major surgical procedure and is often unsuitable for elderly, frail patients.

A congruent, ultra-high molecular weight polyethylene acetabular augment with a stainless steel backing plate has been developed. This can be inserted providing there is no malalignment, wear or loosening of the primary components.

In this study we compared twenty patients who underwent conventional revision surgery to twenty patients who had a PLAD inserted for recurrent posterior dislocation following primary Charnley total hip arthroplasty. Both groups were age and sex-matched and the average number of dislocations prior to surgery was three for each group.

For the PLAD group, the mean operative time, the mean intraoperative blood loss, the time spent in HDU, the transfusion requirements and the duration of hospital stay was significantly less than that for the revision group. Furthermore, there was no significant difference in the Oxford Hip Score recorded preoperatively and at 6 weeks, 6 months, one year and two years following surgery. None of the patients had sustained a further dislocation at latest review.

We conclude that the Posterior Lip Augmentation Device is a safe and effective option in the management of patients with recurrent posterior hip dislocation when there is no evidence of component failure or gross malposition.