David Lhowe, MD, is an Orthopedic Trauma Surgeon, at Massachusetts General Hospital and Assistant Clinical Professor of Orthopaedic Surgery at Harvard Medical School.
Approximately 200,000 total hip replacements and an equal number of hemiarthroplasties are performed annually in the United States. With the marked success of this procedure, patients are able to maintain active lifestyles for many more years. Consequently, millions of elderly are at risk for fracture around their prosthesis.
Periprosthetic fractures typically result from common household falls. The Mayo Clinic reported a 1% prevalence of periprosthetic fracture after primary THR, increasing to 4% following revision surgery (1). Barring dramatic improvements in treating osteoporosis or reducing falls in an aging population, periprosthetic fractures will become an increasing medical and societal burden.
Fortunately, the majority of periprosthetic fractures do not result in implant loosening and may be managed without the need for implant revision. These fractures include the isolated trochanteric fractures (Vancouver A), diaphyseal fractures about a well-fixed stem (Vancouver B1), and fractures well below the distal tip of the stem (Vancouver C). Complex management with revision of components is required when the femoral stem is loose (Vancouver B2) and loosening is further complicated by inadequate bone stock (Vancouver B3). These variants are appropriately referred to experienced hip revision surgeons.
Femur fracture around a well-fixed cemented THR component. Note the presence of a medullary cement plug in the distal fragment.
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Filed under: Hip, Joint Replacement, Medical Education, Orthopaedic, Physician Education, Trauma, Trauma Rounds | Tagged: allograft, fractures, hip replacement, Hip surgery, Joint Replacement, Medical Education, total hip replacement, Trauma, Treatment | 1 Comment »
Diagnosis and Treatment of Periprosthetic Joint Infection
