Michael Brix

1
Periprosthetic Femoral Fractures
Around Well-Fixed Total Hip Artroplasties Results
After Osteosynthesis

• Michael Brix
• Odense University Hospital
• Denmark

2
Introduction

• Traditionally periprostetic fractures around the
  THA with well-fixed stems has been operated by
  traumatologist
• The MIPO tecnique and the use of locked plates
  has been favored at our institution
• Treatment has been according to the Vancouver
  algorithm

3
Materiale and methods

• Postoperative Periprosthetic femoral fractures
  operated at Odense University Hospital from May
  2002-October 2010
• All treated by osteosynthesis
• 64 consecutive ptt (67 fractures) were included.
• Median age was 80 years (range, 49-97 years)
• 15 men and 49 woman

4
Materiale and methods

• Prosthesis
• 58 THA (10 had both THA and TKA in the same leg)
• 9 hemiartroplasties
• Vancouver classification
• 26 B1 fractures
• 1 B2 fracture (misunderstood)
• 40 C fractures

5
Indication
6
Materiale and methods

• Approach
• 57 MIPO (minimal invasive plate osteosynthesis)
• 10 ORIF (open reduction internal fixation)
• Implants
• 55 LISS plates
• 10 LCP plates
• 1 Dall Miles Plate
• 1 Retrograde nail
• All operations but two were done by a
  Traumatologist

7
Results follow up

• whole group 26 months (range, 0-99)
• Patients alive 39 months (range,
  1-99)
• Patients diseased 14 months
  (range, 0-56)
• 33/64 (51) diseased until now.
• 23/64 (36) diseased within the first year after
  surgery

8
Results - union

• Of the 67 fractures
• 11 diseased 0-6 months post operative
• 2 were operated less than 2 months ago
• 4 radiographs were missing
• The remaing 50/50 (100) fractures had union

9
Results - Reoperation
Reoperation N10/67(15)
Failure of fixation N7 (10)
Deep infection N2(2,9)
Loose prosthesis N1(1,5)
Longer plate N2
Revision surgery N2
Revision prosthesis N1
Plate removal N1
Revision prosthesis N4
10
4 reoperations due to new fall had a
revisionprosthesis, because of loose stem.
(stressrisers?)
11
2 reoperations due to new fracture,
stressrisers?? (spanning the prosthesis) they
both had a longere plate
12
Results compared to litterature

• Many case series with 4-39 cases of
  periprosthetic fractures Vancouver type B1 and C
  is reported over years, failure rates from o-50.
  Evidens level IV
• 2 comphrensive articles with review and
  guidelines
• Injury. 2007 Jun38(6)669-87. Epub 2007 Apr 30.
• Principles of internal fixation and selection of
  implants for periprosthetic femoral fractures.
• Giannoudis PV, Kanakaris NK, Tsiridis E.
• Department of Trauma Orthopaedic Surgery,
  Academic Unit, School of Medicine, University of
  Leeds,
• J Am Acad Orthop Surg. 2009 Nov17(11)677-88.
• Principles of treatment for periprosthetic
  femoral shaft fractures around well-fixed total
  hip arthroplasty.
• Pike J, Davidson D, Garbuz D, Duncan CP, O'Brien
  PJ, Masri BA.

13
Conclusion

• Make Vancouver type classification on plain
  radiographs
• Use the Vancouver treatment algorithm for
  periprosthetic fractures
• Stick with basic osteosynthesis principles
• Avoid stress rising area
• Locked plate osteosynthesis and MIPO technique
• can give good results with a high union rate
  and a low reoperations rate

14
Our current concept
Revers LISS Plate LAP device (optional) Cables
(optional) Interfragmentary compression Screw An
d spanning the whole prosthesis