One-stage revision of periprosthetic fractures around loose cemented total hip arthroplasty

Fourteen cases of femoral fracture occurring about a loose cemented proximal femoral prosthesis are presented. All fractures occurred with relatively minor trauma, and significant preinjury osteolysis was present in all cases. Treatment consisted of immediate surgical revision of the loose femoral component using a long-stem noncemented component in conjunction with cerclage wiring. In most instances, morselized bone graft was used. Strut grafts were used in seven cases to improve stability. Two patients with extensive bone loss were unable to support a prosthesis and were treated with whole femoral allografts. Follow-up ranged from 24 to 84 months (mean, 49 months), except for one patient lost to follow-up at 12 months; evaluations consisted of Harris hip scores and radiographic analysis for fracture healing and implant stability. All fractures healed, and patient function increased dramatically. Postoperative Harris hip scores increased to an average of 74 points. Complications consisted of one postoperative fracture and four patients with femoral component loosening. No cases of component loosening were seen in the five cases in which components were designed for distal stability (four fully porous-coated, one fluted). Of the seven cases relying on proximal stability, two cases of early loosening and two cases of late loosening occurred. We recommend revision with long-stem, cementless implants in conjunction with cerclage wiring and strut grafts for the treatment of femoral fractures about loose cemented hip prostheses. Implant stability distal to the fracture is emphasized.