title: Femoral replacement for salvage of periprosthetic fracture around a total hip replacement.
abstract: A total of 20 patients with a mean age of 72 (range: 36-91) were managed with replacement of the proximal (15) or total (5) femur for salvage of a periprosthetic femoral fracture with bone loss. A mean 12.5 years had elapsed between primary total hip replacement and surgery and the mean follow-up was 48 months (range: 12-116 months). Clinical outcome was assessed using the Toronto Extremity Salvage Score (mean: 68, range: 32-98) and Short Form 36 (SF-36; mean Physical Component Score (PCS): 53, range: 44-62; mean Mental Component Score (MCS): 51, range: 41-64). No prostheses were radiologically loose. There were six major complications; three patients suffered a postoperative dislocation; two patients had persistent deep infection (present preoperatively); and one patient suffered a fracture of their femur distal to the femoral stem of a proximal femoral replacement. Endoprosthetic replacement of the femur is a reasonable salvage option for patients with periprosthetic fracture and bone loss, with good clinical results. It allows immediate weight bearing and does not rely on bony union for success.
authors.affiliation: Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: McLean
authors.forename: James T
authors.initials: JT
authors.lastname: Patton
authors.forename: Matthew
authors.initials: M
authors.lastname: Moran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D016474:Weight-Bearing