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[Peri-prosthesis fractures in total hip endoprostheses]
G Blatter1, T Fiechter, F Magerl
1Klinik für Orthopädische Chirurgie, Kantonsspital St. Gallen.
Der Orthopade
|November 1, 1989
Summary
Periprosthetic fractures, breaks around a total hip arthroplasty (THA) prosthesis, require prompt surgical fixation. Treatment strategies vary based on fracture location and prosthesis stability, aiming for fracture healing and joint function restoration.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Trauma Management
Context:
- Periprosthetic fractures complicate total hip arthroplasty (THA) in 0.77% of cases.
- Fractures often occur at the distal prosthesis end (63%) and may involve prosthesis loosening (approx. 33%).
- Fracture patterns vary by location: transverse/oblique distally, spiral more distal, long oblique along the shaft.
Purpose:
- To evaluate outcomes of open reduction internal fixation for periprosthetic fractures after THA.
- To compare different surgical techniques based on fracture characteristics and prosthesis status.
- To establish evidence-based recommendations for managing these complex fractures.
Summary:
- All 33 fractures underwent immediate open reduction internal fixation.
- Follow-up averaged 2.7 years; 28 cases used plate stabilization, 2 involved prosthesis revision, and 1 converted to Girdlestone.
- All fractures healed within one year; specific plate types and bone grafting were used based on fracture location and bone stock.
Impact:
- Recommends large DC plates for distal spiral fractures.
- Suggests wave plates with bone grafts for stable THA fractures at the prosthesis tip or shaft.
- Advocates long-stem prosthesis for loosened fractures with good bone stock, or plating if bone stock is poor, with delayed revision if necessary.