Results of the treatment of proximal femoral periprosthetic fractures

ABSTRACT

Proximal femoral periprosthetic fractures are an uncommon but a major complication of hip arthroplasty. They occur in a particular population combining bad general conditions caracterised by an advanced age and the frequency of comorbidities, and bad local conditions with osteopenia and bone stock loss. The aim of this study was to evaluate the results while treating proximal femoral periprosthetic fractures regarding the recent literature recommendations. Material and methods: This was a retrospective study of 22 proximal femoral periprosthetic fractures treated operatively. According to the Vancouver system modified by the French Society of Orthopaedic Surgery and Traumatology, fractures were classified as AG (n=1), B(n=10), and C(n=11). The mean ASA physical status was 1.6.The average Parker score was 7.8 before the fracture. Ten fractures had open reduction and internal fixation and 12 revision procedures. Morcellised bone grafting was used in 5 cases. The evaluation at last follow up was based on the Parker score, fracture healing, and the screening of the complications. Results: Three patients (4 hips) died post operatively. The average Parker score was 8.3. Eighteen hips in 16 patients were reviewed with a mean follow up of 58,4 months. Union was achieved in nine cases of type B and seven of type C. Four patients presented screw plate or screw pull-out and had treatment failures. Infection occurred in three patients. One patient had pulmonary embolism. Conclusion: Our results showed that treatment of proximal femoral periprosthetic fractures is a highly demanding technique with a high rate of complications. Fractures with loosened implants have to be treated by revision procedure whenever possible