title: Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls.
abstract: Management of periprosthetic fractures around the femoral stem after total hip arthroplasty (THA) represents a significant challenge and optimal treatment remains controversial. The most common treatment paradigm involves treating fractures around a well-fixed stem with osteosynthesis, whereas fractures around a loose stem require revision arthroplasty and those with poor bone require augmentation with bone graft. Paradoxically, the literature reports a higher rate of failure for osteosynthesis around prostheses considered to be well-fixed. Such a high rate of poor outcomes may result not only from difficult fracture fixation and compromised biologic healing, but also from unrecognized peri-implant pathology. Therefore, proper preoperative and intraoperative evaluation is key, and a subset of patients may benefit from alternative management. We review the appropriate methods for evaluation and treatment of Vancouver type B fractures with particular emphasis on avoiding missteps that can lead to failure.
authors.affiliation: Rothman Institute Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Fleischman
authors.affiliation: Rothman Institute Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Antonia F
authors.initials: AF
authors.lastname: Chen
keywords: Periprosthetic fractures; Vancouver type B fracture; revision total hip arthroplasty; total hip arthroplasty