[Peri-prosthesis fractures in total hip endoprostheses]

Periprosthetic fractures after total hip arthroplasty (THA) were found in 0.77% (33 fractures in 4280 THA). At the time of fracture the prosthesis was loose in about one-third of the cases. In most cases (63%), the fracture was located at the distal end of the prosthesis. Fractures at this location were transverse or short oblique; those situated more distally were spiral. Whereas those located along the prosthesis shaft were long oblique. Open reduction internal fixation was performed immediately for all fractures. Thirty patients were followed an average of 2.7 years (1 year-11 years) after fracture. In 28 cases stabilization was obtained using a plate. In 2 cases the prosthesis was changed at the same time as plate stabilization. 1 case the lossened prosthesis was converted to a Girdlestone. A primary change in the prosthesis without osteosynthesis was performed in 2 cases. One year after operation all fractures were healed. We recommend a large DC plate for fractures distal to the tip of the prosthesis (spiral fractures). In cases of stable THA, we stabilized the fracture at the level of the tip of the prosthesis or along the shaft of the prosthesis itself, using a wave plate with corticocancellous bone graft. Fractures along the loosened prosthesis but with good bone stock are treated by implantation of a long-stem prosthesis. If bone stock is poor, we recommend the fracture be stabilized using a plate. Only after the fracture is healed do we revise the prosthesis.