title: A custom-made prosthesis attached to an existing femoral component for the treatment of peri- and sub-prosthetic fracture.
abstract: Peri- and sub-prosthetic fractures, or pathological fractures below an existing well-fixed femoral component, with or without an ipsilateral knee replacement, present a difficult surgical challenge. We describe a simple solution, in which a custom-made prosthesis with a cylindrical design is cemented proximally to the stem of an existing, well-fixed femoral component. This effectively treats the fracture without sacrificing the good hip. We describe five patients with a mean age of 73 years (60 to 81) and a mean follow-up of 47 months (6 to 108). The mean overlap of the prosthesis over the femoral component was 7.5 cm (5.5 to 10). There have been no mechanical failures, no new infections and no re-operations. We suggest that in highly selected cases, in which conventional fixation is not feasible, this technique offers a durable option and avoids the morbidity of a total femoral replacement.
authors.affiliation: Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK. roger.tillman@roh.nhs.uk
authors.forename: R
authors.initials: R
authors.lastname: Tillman
authors.forename: S
authors.initials: S
authors.lastname: Kalra
authors.forename: R
authors.initials: R
authors.lastname: Grimer
authors.forename: S
authors.initials: S
authors.lastname: Carter
authors.forename: A
authors.initials: A
authors.lastname: Abudu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome