Treatment Of Periprosthetic Femoral Fractures After Total Hip Replacement

Purpose:Objective to investigate the treatment of periprosthetic femoral fractures after total hip replacement(THR).Many previous studies have demonstrated that periprosthetic femoral fractures following hip arthroplasty are based on Vancouver classification and different treatment modalities for different fracture types.Preferred to open reduction and internal fixation of Vancouver fracture of type A(ORIF);the preferred ORIF type VancouverB1 fractures,including the use of cable system,locking compression plate(LCP)plate,the less invasive stabilization system(LISS),VancouverB2 and B3 fixator;literature type,deemed necessary joint revision for treatment of Vancouver C;type ORIF.The purpose of this study was to evaluate the efficacy of arthroplasty for some specific types of VancouverBl fractures.Method:From December 2006 through to June 2016,17 cases of Vancouver patients with peripheral type B1 femoral prosthesis in the Second Affiliated Hospital of Zhejiang University School of Medicine Department of orthopedics joint surgery were fractures,including 5 cases of male patients,12 cases were female;the youngest of 37,maximum 86 years old,the average age of 70.4 years.The periprosthetic fracture of femur occurred in 1 months,the longest 288 months after the initial arthroplasty,and the average time of re fracture was 65 months.In 17 cases,were treated with open reduction and internal fixation of Vancouver type B1 periprosthetic femoral fractures without special reasons(ORIF)in 12 cases;5 cases with total hip replacement or femoral revision or steel or titanium cable fixation strapping is the main reason,revision:primary severe osteopenia osteoporosis and femoral prosthesis after fracture is stable but acetabular liner wear knee prosthesis dysfunction,use time is too long and obvious,the normal life is not long expected prosthesis,and elderly patients with more comorbidities,again turn not repair surgery itself body function of opportunity.The prosthesis used for revision surgery included Wagner,Solution,Echelon,and Secur-Fit Max.The postoperative follow-up,so after 3,6,12 months follow-up once a year after year postoperative follow-up time,record the Harris score of hip joint function score,the postoperative X-ray evaluation of periprosthetic fracture healing rate,incidence of postoperative complications and prosthesis stability.Result:All the operative cases were followed up for the shortest time in July and the longest 120 months,with an average follow-up time of 56 months.Of the 5 patients undergoing revision,the amount of bleeding was at least 418ml,with a maximum of 644ml,an average of 531 ml,and 12 cases of internal fixation(ORIF),with the least intraoperative bleeding,256ml,and longer 514ml,with an average of 385 ml.The operation time of the revision case is the shortest,78min,the longest 174 minutes,the average time is 126min,the operation time of the internal fixation cases is the shortest,36min,the longest 108min,the average 72 min.3 months after the operation,all the fractures healed in the revision group,and there were 1 fractures in the internal fixation group without complete union.Internal fixation group Harris hip score a minimum of 50.4 points,the highest 87.points,an average of 68.8 points,the lowest case revision group 66.1 points,the highest 83.9 points,an average of 75 points,and the internal fixation group preoperative Harris hip score a minimum of 36.6 points,the highest 55.8 points,averaging 46.2 points and Harris hip score lowest revision group 44.4 points,the highest 70.4 points,an average of 57.4 points compared differences were statistically significant.In group ORIF there were 1 cases of delayed healing of fracture(August,postoperative healing after surgery)for more than a year with pain in 1 cases(8%),postoperative recurrence of periprosthetic fractures of 1 cases,the complication rate was 42%;1 cases of patients with intraoperative revision of excessive bleeding(more than 500ml),1 cases with surgery after more than a year long pain.Conclusion:For patients with periprosthetic fractures of the femur after total hip arthroplasty,the Vancouver B1 type fractures around the femur should be treated with open reduction and internal fixation(ORIF)in principle.But when the patient's own primary bone loss in severe osteoporosis and femoral prosthesis after fracture is stable but acetabular liner wear knee prosthesis dysfunction,use time is too long and obvious,expected prosthesis normal service life of not long,at the same time and more complications in elderly patients underwent revision surgery again,not much chance one of the options,the artificial joint arthroplasty can also be used as a treatment for Vancouver type B1 fractures.