Extended osteotomy for periprosthetic femoral fractures in total hip arthroplasty.
Total hip arthroplasty periprosthetic fractures that involve a loose prosthesis and are located at or beyond the tip of the prosthesis are difficult to manage and have higher complication and nonunion rates. In this case report, I describe a fracture-site exposure that allows simple insertion of a long, distally fixed revision prosthesis. In an extended femoral osteotomy, the entire proximal fragment opens the upper segment in "clamshell" fashion. The proximal segment is repaired with or without femoral strut allografts and multiple cerclage wires. With this method, 7 periprosthetic fractures united successfully, and none has required further reconstruction.
Medical College of Wisconsin, Columbia St. Mary's Hospital, Milwaukee, Wisconsin, USA. jbstiehl@aol.com
James B
JB
Stiehl
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005264:Femoral Fractures / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011475:Prosthesis Failure; D012086:Reoperation; D018570:Risk Assessment; D016896:Treatment Outcome