eMedicine Specialties > Orthopedic Surgery > Trauma

Periprosthetic Fractures: Follow-up

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

Outcome and Prognosis

A good outcome and prognosis is expected if the surgeon restores the biomechanical function of the limb. Failure to do so results in a poor outcome.

When treating periprosthetic fractures, the surgeon must evaluate the stability of the implant carefully. Loose implants used for fixation allow motion at the fracture site that interferes with healing and physically interferes with the placement of more stable fracture fixation. Loose prostheses used for joint replacement are painful and interfere with adequate fracture fixation. If the implant is loose or malaligned, the implant should be revised while the fracture is fixed at the same setting. If the implant is stable and sufficient bone stock is available for fracture stabilization, the implant should be retained while the fracture is fixed using standard treatment principles. When treating peri-implant fractures of the femur, the surgeon should have a flexible approach, using the best-fitting device, following basic fracture principles of rigid internal fixation and restoration of the anatomy and preservation of soft tissue attachments.

For optimal results when treating periprosthetic fractures, assess the stability of the fracture, restore mechanical stability, respect the biological environment, and have flexibility and choose the device that fits.

Future and Controversies

Current efforts to treat periprosthetic fractures focus on ways to avoid the fracture and new implants for improved fixation. New designs of replacement prostheses include changes in the shape of stems to better share load with the bone and avoid the osteoporosis of stress shielding, which weakens the bone and predisposes for fracture. New plate designs, such as the low contact dynamic compression plate, decrease the contact area of plates and decrease the osteoporosis of stress shielding. Changes in materials decrease bone destruction from osteolysis. Less rigid metals (eg, such as titanium vs stainless steel) share the load better. Fixed-angle plate systems (eg, LISS), allow more stable fixation with minimally invasive techniques (see image below).

Open reduction internal fixation with 2 "combi" f...

Open reduction internal fixation with 2 "combi" fixed-angle locking screw plates (anterior and lateral placement to help control both anterolateral and mediolateral forces).

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Open reduction internal fixation with 2 "combi" f...

Open reduction internal fixation with 2 "combi" fixed-angle locking screw plates (anterior and lateral placement to help control both anterolateral and mediolateral forces).


 


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

  1. Ricci WM, Borrelli J Jr. Operative management of periprosthetic femur fractures in the elderly using biological fracture reduction and fixation techniques. Injury. Sep 2007;38 Suppl 3:S53-8. [Medline].

  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.

  9. Culp RW, Schmidt RG, Hanks G, et al. Supracondylar fracture of the femur following prosthetic knee arthroplasty. Clin Orthop. Sep 1987;(222):212-22. [Medline].

  10. Blaster RB, Matthews LS. A Complications of Prosthetic Knee Arthroplasty in Complications. In: Epps CH, ed. Othopaedic Surgery. 3rd ed. Philadelphia, Pa: JB Lippincott;1994:1057-1088.

  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].

  12. Ritter MA, Faris PM, Keating EM. Anterior femoral notching and ipsilateral supracondylar femur fracture in total knee arthroplasty. J Arthroplasty. 1988;3(2):185-7. [Medline].

  13. Talbot M, Zdero R, Schemitsch EH. Cyclic loading of periprosthetic fracture fixation constructs. J Trauma. May 2008;64(5):1308-12. [Medline].

  14. Anakwe RE, Aitken SA, Khan LA. Osteoporotic periprosthetic fractures of the femur in elderly patients: Outcome after fixation with the LISS plate. Injury. May 19 2008;[Medline].

  15. Rosenberg AG, ed. A Total Hip Arthroplasty and A Total Knee Arthroplasty in Orthopaedic Knowledge Update 5. Rosemont, Ill:. American Academy of Orthopaedic Surgeons;1996:397,486.

  16. Large TM, Kellam JF, Bosse MJ, Sims SH, Althausen P, Masonis JL. Locked Plating of Supracondylar Periprosthetic Femur Fractures. J Arthroplasty. Jul 8 2008;[Medline].

  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].

  18. Johansson JE, McBroom R, Barrington TW, Hunter GA. Fracture of the ipsilateral femur in patients wih total hip replacement. J Bone Joint Surg Am. Dec 1981;63(9):1435-42. [Medline].

  19. Muller ME, Allgower M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. New York, NY: Springer-Verlag;1991:1-112.

  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.

  22. Fitzgerald RH Jr, Brindley GW, Kavanagh BF. The uncemented total hip arthroplasty. Intraoperative femoral fractures. Clin Orthop. Oct 1988;(235):61-6. [Medline].

  23. Schmotzer H, Tchejeyan GH, Dall DM. Surgical management of intra- and postoperative fractures of the femur about the tip of the stem in total hip arthroplasty. J Arthroplasty. Sep 1996;11(6):709-17. [Medline].

  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: eMedicine Salary Employment

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, FACS, Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center
Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

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