title: Surgical treatment of periprosthetic femoral fractures following hip arthroplasty: our institutional experience.
abstract: OBJECTIVE
  Periprosthetic fractures are one of the most serious complications after hip replacement. The aim of this retrospective study was to evaluate the clinical outcome of surgical treatment of periprosthetic femoral fractures following total hip arthroplasty using treatment algorithm of the Vancouver classification.
  
  
  METHODS
  Fifty six periprosthetic femoral fractures operated on during the period December 2004-September 2013 were followed-up retrospectively. There were 40 women and 16 men with mean age at the time of surgery 64.7 years (41-88 years). The mean follow-up for the group was 5 years (range, 1-10 years). Periprosthetic fractures were classified according to the Vancouver classification. The clinical evaluation was performed with the Harris hip score, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Short Form 8 (SF-8). Bone healing, implant survival, pain, function and complications were recorded. Bone healing and implant stability were evaluated clinically and on plain radiographs.
  
  
  RESULTS
  Uneventful bone healing was achieved in 52 cases. In two fractures (one type B1, one type C) nonunion and plate failure occurred. Two cemented stems were revised for aseptic loosening 6.5 and 7 years after fracture fixation. Uncontrollable prosthesis infection and sepsis in a rheumatoid (immunocompromised) patient required disarticulation of the involved extremity.
  
  
  CONCLUSIONS
  Periprosthetic femoral fractures are difficult to treat and require complex treatment approach according to risk assessment, fracture type, implant stability, bone stock and medical status of the patient. Using a treatment protocol of the Vancouver classification we obtained satisfactory outcome.
authors.affiliation: Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Medical University of Sofia, ul. Bialo more 8, 1527 Sofia, Bulgaria.
authors.forename: Plamen
authors.initials: P
authors.lastname: Kinov
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, EMMS Medical Center, Nazaret, Israel; The Galilee Medical Faculty Sfad, Bar Ilan University, Israel. Electronic address: volpinger@gmail.com.
authors.forename: Gershon
authors.initials: G
authors.lastname: Volpin
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Hillel Yafe Medical Center, Hadera, Israel.
authors.forename: Roger
authors.initials: R
authors.lastname: Sevi
authors.affiliation: Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Medical University of Sofia, ul. Bialo more 8, 1527 Sofia, Bulgaria.
authors.forename: Panayot P
authors.initials: PP
authors.lastname: Tanchev
authors.affiliation: Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Medical University of Sofia, ul. Bialo more 8, 1527 Sofia, Bulgaria.
authors.forename: Boris
authors.initials: B
authors.lastname: Antonov
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, EMMS Medical Center, Nazaret, Israel; The Galilee Medical Faculty Sfad, Bar Ilan University, Israel.
authors.forename: Geries
authors.initials: G
authors.lastname: Hakim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D001860:Bone Plates; D005260:Female; D005264:Femoral Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: Hip arthroplasty; Osteosynthesis; Outcome; Periprosthetic fracture; Revision; Vancouver classification