eMedicine Specialties > Orthopedic Surgery > Trauma

Periprosthetic Fractures: Workup

Author: Steven I Rabin, MD, Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic
Contributor Information and Disclosures

Updated: Dec 19, 2008

Workup

Laboratory Studies

  • No special laboratory studies are required for most periprosthetic fractures. A sedimentation rate and CBC count with differential is useful if infection is suspected.

Imaging Studies

  • Radiographs of the entire bone are required to assess the condition of the joint above and below the fracture, condition of the implant, presence of deformity or lesions that may influence surgical options, and axial alignment of the bone. Two views perpendicular to each other, most often an anteroposterior (AP) and lateral view of the bone, are always required.
  • CT scan and MRI have limited use because of scatter artifact caused by the metallic implant. Bone scans are not specific.

Diagnostic Procedures

  • Aspiration of a failed joint replacement may help if infection is suspected.

Histologic Findings

Biopsy at the time of surgery is indicated if pathologic fracture or infection is suspected.

More on Periprosthetic Fractures

Overview: Periprosthetic Fractures
Workup: Periprosthetic Fractures
Treatment: Periprosthetic Fractures
Follow-up: Periprosthetic Fractures
Multimedia: Periprosthetic Fractures
References
Further Reading
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References

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  2. Wu CC, Shih CH. Ipsilateral femoral neck and shaft fractures. Retrospective study of 33 cases. Acta Orthop Scand. Aug 1991;62(4):346-51. [Medline].

  3. Eingartner C, Ochs U, Egetemeyer D, Volkmann R. Treatment of periprosthetic femoral fractures with the Bicontact revision stem. Z Orthop Unfall. Sep-Oct 2007;145 Suppl 1:S29-33. [Medline].

  4. Sisto DJ, Lachiewicz PF, Insall JN. Treatment of supracondylar fractures following prosthetic arthroplasty of the knee. Clin Orthop. Jun 1985;(196):265-72. [Medline].

  5. Kumar A, Chambers I, Maistrelli G, Wong P. Management of periprosthetic fracture above total knee arthroplasty using intramedullary fibular allograft and plate fixation. J Arthroplasty. Jun 2008;23(4):554-8. [Medline].

  6. Figgie MP, Goldberg VM, Figgie HE 3rd, et al. The results of treatment of supracondylar fracture above total knee arthroplasty. J Arthroplasty. Sep 1990;5(3):267-76. [Medline].

  7. Cook RE, Jenkins PJ, Walmsley PJ, Patton JT, Robinson CM. Risk factors for periprosthetic fractures of the hip: a survivorship analysis. Clin Orthop Relat Res. Jul 2008;466(7):1652-6. [Medline].

  8. Koval KJ, Frankel VH, Kummer F, Green S. A complications of fracture fixation devices. In: Epps CH, ed. Complications in Orthopaedic Surgery. 3rd ed. Philadelphia, Pa: JB Lippincott;1994:131-54.

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  11. Chmell MJ, Moran MC, Scott RD. Periarticular Fractures After Total Knee Arthroplasty: Principles ofManagement. J Am Acad Orthop Surg. Mar 1996;4(2):109-116. [Medline].

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  17. Mihalko WM, Beaudoin AJ, Cardea JA. Finite-element modelling of femoral shaft fracture fixation techniquespost total hip arthroplasty. J Biomech. May 1992;25(5):469-76. [Medline].

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  20. Shaw JA, Greer RB III. A complications of total hip replacement in complications. In: Epps CH Jr, ed. Orthopaedic Surgery. 3rd ed. Philadelphia, Pa: JB Lippincott;1994:1013-1056.

  21. Azer SN, Rankin EA. A complications of treatment of femoral shaft fractures. In: Epps CH, ed. Complications in Orthopaedic Surgery. 3rd ed. Philadelphia, Pa: JB Lippincott;1994:487-524.

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  24. Bhattacharyya T, Chang D, Meigs JB, Estok DM 2nd, Malchau H. Mortality after periprosthetic fracture of the femur. J Bone Joint Surg Am. Dec 2007;89(12):2658-62. [Medline].

  25. Lohrbach, Rabin S. Presented at the MidAmerica Orthopedic Association Annual Meeting. 2002.

  26. Zdero R, Walker R, Waddell JP, Schemitsch EH. Biomechanical evaluation of periprosthetic femoral fracture fixation. J Bone Joint Surg Am. May 2008;90(5):1068-77. [Medline].

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Keywords

periprosthetic fractures, peri-implant fractures, implant fractures, knee arthroplasty, femoral fractures, hip replacement, wrist arthritis

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Contributor Information and Disclosures

Author

Steven I Rabin, MD, Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic
Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Fracture Association, AO Foundation, and Orthopaedic Trauma Association
Disclosure: Nothing to disclose.

Medical Editor

James F Kellam, MD, Vice-Chair, Department of Orthopedic Surgery, Director of Orthopedic Trauma and Education, Carolinas Medical Center
James F Kellam, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Samuel Agnew, MD, FACS, Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center
Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FAAOS, Chairman, J Vernon Luck Distinguished Professor, Department of Orthopedic Surgery, University of Missouri
Jason H Calhoun, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and American Orthopaedic Foot and Ankle Society
Disclosure: Nothing to disclose.

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