ABSTRACT
BACKGROUND:: Hip arthroplasties are increasing worldwide resulting in an increasing number of periprosthetic fractures. These fractures are difficult to treat with various the different fixation or revision options described, many of which have high complication rates. PURPOSE:: To investigate whether our described method of treating periprosthetic fractures is an effective, safe and reproducible method of treating patients. METHODS:: We describe the largest series of a cable plate fixation system combined with a single cortical strut allograft to treat patients with periprosthetic fractures of the hip (Unified Classification System B1 and selected B2, C and D). RESULTS:: Between July 2006 and March 2015, 28 patients were treated using this method. The mean follow-up was 2.2 years (3 months to 9 years). The mean Oxford Hip Score (OHS) at final follow-up was 32 and the mean modified Harris Hip Score (mHHS) 67. There were 3 complications including 1 failure that required revision surgery, 1 case of infection successfully treated with debridement, antibiotics and retention, and a case of discomfort from the metalwork which we managed conservatively. CONCLUSION:: This method of anatomical restoration of the femur with dual-plane fixation is a highly effective method of treating this complex group of patients, and should be considered as a first line of treatment. It shows that there is a role for successful treatment with internal fixation of certain B2, C and D fractures with this technique.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Bone Plates , Bone Transplantation , Femoral Fractures/surgery , Fracture Fixation, Internal/instrumentation , Periprosthetic Fractures/surgery , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/methods , Female , Femoral Fractures/etiology , Fracture Fixation, Internal/methods , Hip Prosthesis/adverse effects , Humans , Male , Middle Aged , Periprosthetic Fractures/etiology , Reoperation/methods , Transplantation, HomologousABSTRACT
Radiographs of 100 primary cemented total hip arthroplasties were studied. Acetabular component positioning and cement mantles were assessed with respect to implant type, grade of surgeon, and operated side. Seventy-eight percent of the components were eccentrically placed, with increasing cement mantle thickness from zone 1 to zone 3. Concentricity occurred in only 13% of the Charnley Ogee and in 28% of the IP Lubinus components. The Charnley Ogee was more superiorly placed than the IP Lubinus (P < .001). Surgical grade affected neither cement mantle thickness nor opening angle. In vitro studies ideally recommend concentric placement of the acetabular component. This appears difficult to achieve consistently in vivo in most patients using the components in this study.
