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KMID : 0361620100450020114
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Journal of the Korean Orthopaedic Association
2010 Volume.45 No. 2 p.114 ~ p.119
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Treatment of Periprosthetic Femoral Fractures after Hip Arthroplasty
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Lee Joong-Myung
Hwang Dae-Woo
Choi Hee-Joon
Seol Yong-Dong
Lee Don-Seok
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Abstract
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Purpose: To determine results of treatment according to the guidelines of the Vancouver classification in periprosthetic femoral fractures after total hip arthroplasty.
Materials and Methods: Among 44 cases of periproshtetic femoral fractures after hip arthroplasty treated between Aug. 1991 and Feb. 2008, thirty-two cases with minimum follow-up greater than one year were included. Outcomes were evaluated using the Beals and Tower’s critieria.
Results: Outcomes were excellent in 27 cases, and poor in 5 cases. Four of 5 cases with poor result were due to non-union. Three cases were treated with internal fixation and 1 case was treated with a conservative method. One case with a poor result was due to loosening of the cemented stem of a Vancouver type B1 fracture. Loosening of the stem after mid to long term follow up occurred in an additional 4 cases (3 cases with a cemented stem in a type B1 fracture, 1 case with a cemented stem of a type C fracture). Loosened stems were revised with a long revision stem.
Conclusion: For type B1 periprosthetic fractures around a cementless stem, and for type B2, type B3 periprosthetic fractures, treatment according to the guidelines of the Vancouver classification showed excellent results. However, type B1 periprosthetic fractures around a cemented stem showed poor results with non-union or stem loosening. Hence, more rigid fixation using a bone graft or revision of the stem is needed. In type C periprosthetic fractures in osteoporotic patients, closer attentions is needed to avoid complications.
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KEYWORD
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periprosthetic femoral fracture, vancouver classification, total hip arthroplasty
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