Classification and treatment of periprosthetic femoral fractures after hip arthroplasty / 中华骨科杂志

ABSTRACT

With the increasing number of hip arthroplasty and the extension of implant survival,the risk of periprosthetic femoral fractures are gradually growing.The technical challenge of the surgical management of periprosthetic femoral fractures leads to poor functional outcome,implant survival and patient satisfaction compared to primary hip arthroplasty.The risk factors of periprosthetic femoral fractures involve both of the bone quality of the patient and the surgical techniques of the primary surgery,including age and gender of the patient,osteoporosis,previous surgical history and the type of the components.In order to avoid the occurrence of periprosthetic fractures,precautions including the assessment of the patient status and bone quality as well as the selection of proper prosthesis and surgical procedures should be taken before the primary surgery.During the primary surgery,more attention should be paid to prevent the damage of host bone and make sure the correct placement of the implants.The aseptic loosening should be detected and treated as early as possible in the regular post-operative follow up.The diagnosis of periprosthetic femoral fracture mainly bases on the detailed history,symptoms,signs and serial X-rays after operation.The most extensively used classification system of the periprosthetic femoral fracture is the Vancouver classification.For the treatment of different types of fractures,conservative therapy is recommended for most Vancouver type A fractures.The surgical management is the best choice for most Vancouver type B fractures.Whether the stem revision is necessary or not depends on the stability the component.The treatment of Vancouver type C fractures should be in accordance with the principles of regular femur fractures.However,more attention should be paid to choose proper device according to the existence of the femoral component in the proximal part of the fracture.Through the analysis of the pathogenesis and risk factors of periprosthetic femoral fractures and the discussion of the diagnosis,classification and treatment principles,we expect to provide a standard treatment protocol for the periprosthetic femoral fractures following hip arthroplasty.