title: A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement.
abstract: Peri-prosthetic fractures (PPF) are a recognised complication following hip arthroplasty. Prosthesis design and type influence PPF pattern. Surgeons rely on classification systems, such as the Vancouver, to aid treatment planning. This study highlights a specific fracture pattern that occurs with cemented well-fixed polished, tapered, collarless (PTC) stems. We reviewed a consecutive series of 21 PPF around well fixed PTC stems. The majority of the fractures were classified pre-operatively as Vancouver B2 (14/21), but there were also B1 (6/21) and A type fractures. The B2 fractures had common radiological and intra-operative findings: a spiral fracture with extensive fragmentation of bone and cement, debonding of cement from the implant, cement fracture, and a well-fixed cement-bone interface. Reconstruction of these fractures was more difficult than suggested by the radiographs. Two of the six patients who were considered to have a Vancouver B1 fracture underwent open reduction and internal fixation (ORIF), and had treatment-related complications. Retrospective review of the radiographs showed subtle features, such as subsidence of the stem into the centraliser, that are characteristic of a B2 fracture pattern. In summary, it is important to recognise this fracture pattern around secure PTC stems in order to prevent misinterpretation of the fracture as a Vancouver B1 rather than a B2, leading to failure of treatment, and to alert the surgeon that complex reconstruction will be required because of the extensive fragmentation.
authors.affiliation: NDORMS, University of Oxford, United Kingdom. george.grammatopoulos@ndorms.ox.ac.uk
authors.forename: George
authors.initials: G
authors.lastname: Grammatopoulos
authors.forename: Hemant
authors.initials: H
authors.lastname: Pandit
authors.forename: Gregoris
authors.initials: G
authors.lastname: Kambouroglou
authors.forename: Mark
authors.initials: M
authors.lastname: Deakin
authors.forename: Roger
authors.initials: R
authors.lastname: Gundle
authors.forename: Peter
authors.initials: P
authors.lastname: McLardy-Smith
authors.forename: Adrian
authors.initials: A
authors.lastname: Taylor
authors.forename: David
authors.initials: D
authors.lastname: Murray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D001843:Bone Cements; D005260:Female; D005264:Femoral Fractures / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D001843:Bone Cements