title: Treatment of periprosthetic femoral fractures by effective lengthening of the prosthesis.
abstract: The increasing number of hip and knee arthroplasties implies a greater likelihood of periprosthetic fractures and need for successful treatment options. We asked whether in situ effective lengthening of the indwelling prosthesis by a custom-made slotted hollow intramedullary nail provided a reasonable alternative to the established internal fixation techniques and prosthesis exchange. Between 1994 and 2005, we treated 25 patients (four male and 21 female; average age, 80 years) with a hip or knee periprosthetic fracture using this technique. Preconditions included a well-fixed prosthesis with a conical tip. In 23 hip cases a retrograde femur nail and in two knee fracture cases an antegrade nail were used for in situ lengthening of a femoral hip or knee implant stem. In all 25 cases, we used a preoperatively manufactured custom-made implant; in 20 patients, we recommended immediate mobilization by partial or full weightbearing. Eighteen of 25 patients were followed a minimum of 7 months (mean, 25 months; range, 7-31 months). Three patients died and four were lost to followup. We observed fracture healing in all patients, but one female patient had subsequent prosthesis loosening. The major complication rate was 6% (one of 18). We believe effective lengthening of the indwelling prosthesis by a custom-made slotted hollow intramedullary nail is a reasonable option for treating periprosthetic femoral fractures.
authors.affiliation: Department of Trauma Surgery Giessen, University Hospital of Giessen and Marburg, Rudolf-Buchheim-Strasse 7, 35835 Giessen, Germany. christof.meyer@chiru.med.uni-giessen.de
authors.forename: Christof
authors.initials: C
authors.lastname: Meyer
authors.forename: Volker
authors.initials: V
authors.lastname: Alt
authors.forename: Ludwig
authors.initials: L
authors.lastname: Schroeder
authors.forename: Christian
authors.initials: C
authors.lastname: Heiss
authors.forename: Reinhard
authors.initials: R
authors.lastname: Schnettler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000295:instrumentation; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D017102:Fracture Healing; D006622:Hip Prosthesis; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies