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Treatment of periprosthetic femoral fractures after femoral revision using a long stem

BACKGROUND: Periprosthetic femoral fractures are becoming increasingly common and are a major complication of total hip arthroplasty and hemiarthroplasty. The treatment of periprosthetic femoral fracture after femoral revision using a long stem is more complex and challenging. The purpose of this st...

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Autores principales: Kim, Youngwoo, Tanaka, Chiaki, Tada, Hiroshi, Kanoe, Hiroshi, Shirai, Takaaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494722/
https://www.ncbi.nlm.nih.gov/pubmed/25958328
http://dx.doi.org/10.1186/s12891-015-0565-7
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author Kim, Youngwoo
Tanaka, Chiaki
Tada, Hiroshi
Kanoe, Hiroshi
Shirai, Takaaki
author_facet Kim, Youngwoo
Tanaka, Chiaki
Tada, Hiroshi
Kanoe, Hiroshi
Shirai, Takaaki
author_sort Kim, Youngwoo
collection PubMed
description BACKGROUND: Periprosthetic femoral fractures are becoming increasingly common and are a major complication of total hip arthroplasty and hemiarthroplasty. The treatment of periprosthetic femoral fracture after femoral revision using a long stem is more complex and challenging. The purpose of this study was to identify the clinical and radiographical features of periprosthetic femoral fractures after revision using a long stem. METHODS: We report a retrospective review of the outcomes of treatment of 11 periprosthetic fractures after femoral revision using a long stem. Eleven female patients with a mean age of 79.2 years (70 to 91) were treated for a Vancouver type B1 fracture between 1998 and 2013. The mean numbers of previous surgeries were 3.1 (2 to 5). RESULTS: The average follow-up was 58.9 months (8 to 180). We found several important features that might influence the outcome of treatment for periprosthetic femoral fractures after femoral revision using a long stem: 1) all cases were classified as Vancouver type B1. 2) 6 patients (55%) had a transverse fracture around the tip of the long stem. 3) 7 patients (64%) had a history of previous fracture of the ipsilateral femur. The type B1 fractures were treated with open reduction and internal fixation in 9 hips, 6 of which were reinforced with bone grafts. Two other periprosthetic fractures were treated with femoral revision. One was revised because of stem breakage, and the other was a transverse fracture associated with poor bone quality, which received a femoral revision with a long stem and a plate. All fractures except one achieved primary union. This failed case had a bone defect at the fracture site, and revision surgery using a cementless long stem and allografts was successful. CONCLUSIONS: These findings suggest that most cases of type B1 fracture after revision using a long stem have been treated successfully with open reduction and internal fixation. However, a transverse fracture with very poor bone quality might be considered as a type B3 fracture, and femoral revision might be a treatment of choice.
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spelling pubmed-44947222015-07-08 Treatment of periprosthetic femoral fractures after femoral revision using a long stem Kim, Youngwoo Tanaka, Chiaki Tada, Hiroshi Kanoe, Hiroshi Shirai, Takaaki BMC Musculoskelet Disord Research Article BACKGROUND: Periprosthetic femoral fractures are becoming increasingly common and are a major complication of total hip arthroplasty and hemiarthroplasty. The treatment of periprosthetic femoral fracture after femoral revision using a long stem is more complex and challenging. The purpose of this study was to identify the clinical and radiographical features of periprosthetic femoral fractures after revision using a long stem. METHODS: We report a retrospective review of the outcomes of treatment of 11 periprosthetic fractures after femoral revision using a long stem. Eleven female patients with a mean age of 79.2 years (70 to 91) were treated for a Vancouver type B1 fracture between 1998 and 2013. The mean numbers of previous surgeries were 3.1 (2 to 5). RESULTS: The average follow-up was 58.9 months (8 to 180). We found several important features that might influence the outcome of treatment for periprosthetic femoral fractures after femoral revision using a long stem: 1) all cases were classified as Vancouver type B1. 2) 6 patients (55%) had a transverse fracture around the tip of the long stem. 3) 7 patients (64%) had a history of previous fracture of the ipsilateral femur. The type B1 fractures were treated with open reduction and internal fixation in 9 hips, 6 of which were reinforced with bone grafts. Two other periprosthetic fractures were treated with femoral revision. One was revised because of stem breakage, and the other was a transverse fracture associated with poor bone quality, which received a femoral revision with a long stem and a plate. All fractures except one achieved primary union. This failed case had a bone defect at the fracture site, and revision surgery using a cementless long stem and allografts was successful. CONCLUSIONS: These findings suggest that most cases of type B1 fracture after revision using a long stem have been treated successfully with open reduction and internal fixation. However, a transverse fracture with very poor bone quality might be considered as a type B3 fracture, and femoral revision might be a treatment of choice. BioMed Central 2015-05-10 /pmc/articles/PMC4494722/ /pubmed/25958328 http://dx.doi.org/10.1186/s12891-015-0565-7 Text en © Kim et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kim, Youngwoo
Tanaka, Chiaki
Tada, Hiroshi
Kanoe, Hiroshi
Shirai, Takaaki
Treatment of periprosthetic femoral fractures after femoral revision using a long stem
title Treatment of periprosthetic femoral fractures after femoral revision using a long stem
title_full Treatment of periprosthetic femoral fractures after femoral revision using a long stem
title_fullStr Treatment of periprosthetic femoral fractures after femoral revision using a long stem
title_full_unstemmed Treatment of periprosthetic femoral fractures after femoral revision using a long stem
title_short Treatment of periprosthetic femoral fractures after femoral revision using a long stem
title_sort treatment of periprosthetic femoral fractures after femoral revision using a long stem
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494722/
https://www.ncbi.nlm.nih.gov/pubmed/25958328
http://dx.doi.org/10.1186/s12891-015-0565-7
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