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Abstract
Periprosthetic fractures of the femur after total hip replacement can present some unique challenges to the treating reconstructive orthopedic surgeon. Treatment may differ depending on fracture location, bone condition, implant stability, patient characteristics, and surgeon experience. It is imperative that adequate and sufficient mechanical fixation be achieved in the treatment of these patients. It is crucial that the treating orthopaedic surgeon have a clear and effective treatment plan to manage these complex cases. The patient's final outcome is dependent on fracture union, implant stability, early functional recovery, and return to pre-injury independence. This review presents an oven'iew of the current diagnostic and treatment approaches, with the goal of providing a template for optimal decision-making when dealing with these complex injuries.
Total hip arthroplasty (THA) has been an extremely effective procedure in relieving pain and dysfunction for patients with hip arthritis of varying etiologies. However, after many decades of successful total hip replacements, there has also been a substantial increase in the incidence of periprosthetic fractures following THA. This increase in fracture prevalence is attributed to the substantial increase in the number of primary and revision THAs being performed annually, the growing number of patients with a THA in place for more than 20 years, the aging population of THA patients (with increasing life expectancy, poorer bone quality, and high fall risk), and broader indications for THA that allow younger, more active, and consequently high-energy trauma prone patients to undergo the surgery.
Periprosthetic femur fractures are divided into intraoperative tive and postoperative fractures. Intraoperative fractures occur cur during the course of surgery and postoperative fractures, the main focus of this review, usually occur within days to several years after the procedure. In a Swedish National Hip Arthroplasty registry study, the mean time from THA to fracture was 7.4 years for primary THA and 3.9 years for revision THA.1 Also, in a Mayo Clinic Total Joint Registry study, average time between primary THA and fracture was 8.1 years.2
Periprosthetic femoral fractures may present many challenges to the reconstructive orthopedic surgeon. Such fractures can range from minor injuries, with minimal effect on the patient's outcome to being catastrophic and possibly creating a non-reconstructable problem with a detrimental effect on the patient's function. The economic impact...