Management of the hip periprosthetic fractures

Abstract

The purpose of the study: The analysis of the treatment methods in periprosthetic fractures after hip arthroplasty, with correlation between the experience of the authors and literature data. Methods: During the years 2010-2014 in our clinic were performed 67 revision surgical procedures of periprosthetic fractures after the hip replacements. Of these 25 were males and 42 were females; the mean cohort age was 64 year, ranging from 54 ap to 79 years. Elapsed time from the primary arthroplasty up to the revision of the periprosthetic fractures varied from 2 months up to the 13 years. Cases were staggered according to Vancouver classification. We have encountered fractures of type AG in 4 cases, type AL - 3 cases, type B1 – 12 cases, type B2 – 14 cases, type B3 – 7 cases, type C – 27 cases. Fractures of the type A have been treated with simple wire fixation (4 cases) tension band wiring (3 cases). Fractures of the type B1 were treated by the plate osteosynthesis; type B2 and B3 – by revision arthroplasty. In fractures type C we performed the osteosyntesis by the plates with angular stability in 15 cases or regular plates with association of the bone grafts in 12 cases. Results: In fractures of the type A we found one case of osteosyntesis instability, which was well tolerated by the patient. Fractures of the type B represent one of the biggest problems. Especially type B1 and B2, when was difficult to differentiate if the stem was stable or not. In 3 cases we did mistakes in appreciation of the type B1 and performed the osteosyntesis. In all these cases occured the instability of the stem, that led to the revision arthroplasty procedure. In cases of the fractures type C we met the problem of the associated osteoporosis. This led to technical difficulties in achieving stable osteosynthesis by regular plates. Conclusions: The results confirm that correct classification, compliance with treatment protocols of the hip periprosthetic fractures and strict differencition between different types of the fractures can lead to good functional result.