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Periprosthetic Femoral Fractures-Beyond B2.

Chika Edward Uzoigwe1, Arun Thor Watts, Praise Briggs

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Periprosthetic femoral fractures (PFFs) are increasing with hip replacements. New evidence suggests fixation may be a viable alternative to revision surgery for certain B2 PFFs.

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Area of Science:

  • Orthopedic Surgery
  • Biomaterials Engineering
  • Biomechanics

Background:

  • Hip arthroplasty (hip replacement) proliferation has led to more periprosthetic femoral fractures (PFFs).
  • The most frequent type, B2 PFFs, are linked to polished taper-slip cemented stems that tend to subside in cement.
  • These specific prostheses exhibit a higher PFF risk compared to other cemented designs.

Purpose of the Study:

  • To investigate the mechanopathogenesis of B2 periprosthetic femoral fractures.
  • To evaluate fixation as an alternative treatment to revision arthroplasty for specific B2 PFF cases.
  • To highlight advances in understanding and management of B2 PFFs.

Main Methods:

  • Analysis of national registry data to identify trends in PFFs and prosthesis design.
  • Review of biomechanical principles underlying stem subsidence and prosthesis migration.
  • Evaluation of existing literature on fixation versus revision arthroplasty outcomes for B2 PFFs.

Main Results:

  • Highly polished, low-friction cemented prostheses, particularly cobalt-chromium stems, show a propensity for migration within cement, increasing B2 PFF risk.
  • Emerging evidence indicates that fixation can yield outcomes comparable to revision arthroplasty for B2 PFFs with an intact bone-cement interface.
  • Fixation offers potential benefits including shorter surgical duration, reduced transfusion needs, and lower dislocation rates.

Conclusions:

  • Periprosthetic femoral fractures (PFFs) are a growing concern in hip arthroplasty, with B2 fractures linked to specific cemented stem designs.
  • Fixation is emerging as a potentially effective treatment for select B2 PFFs, offering comparable outcomes to revision surgery with added benefits.
  • Further understanding of PFF mechanopathogenesis supports refined indications for fixation in managing these complex fractures.