instructional course lectures, the american academy of orthopaedic surgeons - periprosthetic...

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Periprosthetic Fracture of the

Femur after Total Hip Arthroplasty. Treatment and Results to Date*†

by DAVID G. LEWALLEN, and DANIEL J. BERRY

J Bone Joint Surg AmVolume 79(12):1881-90

December 1, 1997

©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1 Graph showing the number of postoperative fractures of the femur after ipsilateral total hip arthroplasty at the Mayo Clinic during a twenty-five-year period beginning in 1971.

DAVID G. LEWALLEN, and DANIEL J. BERRY J Bone Joint Surg Am 1997;79:1881-90


Fig. 2 Bar graph showing the diagnoses that led to revision total hip arthroplasty at the Mayo Clinic between 1989 and 1993.



Fig. 3-A: Radiograph of a hip that had loosening of the implant, osteolysis, and pain seven years after a total hip arthroplasty.



Fig. 3-B: Three months later, after a misstep, the patient sustained a periprosthetic fracture through an osteolytic defect.



Fig. 4-A Radiograph showing a periprosthetic fracture through an area of cortical perforation and extravasation of cement at the time of a revision total hip arthroplasty.



Fig. 4-B Treatment in the presence of a well fixed stem consisted of insertion of a plate with screws distally and cerclage bands proximally, with bone-grafting of the fracture line and the

defect.



Fig. 5 Intraoperative photograph showing onlay cortical strut allograft held with cerclage cables spanning a periprosthetic fracture.



Fig. 6-A Radiograph of a hip with loosening, osteolysis, and a periprosthetic fracture that was neglected because of inadequate medical and radiographic follow-up.



Fig. 6-B: Intraoperative photograph showing replacement of the damaged proximal aspect of the femur with a composite consisting of an allograft and a prosthesis.



Fig. 6-C: The proximal femoral remnants and the trochanter were preserved and secured to the allograft to improve function and stability of the hip.



Fig. 6-D Radiograph showing the final construct.



Fig. 7 Photograph showing a modular proximal femoral replacement stem, which can be useful for the treatment of massive bone loss and a fracture of the proximal part of the femur.



Fig. 8 Radiographs made after ill advised closed treatment, with traction, of a periprosthetic fracture associated with a loose stem.



Fig. 9 Radiograph made after onlay strut-grafting and use of an extensively porous-coated stem.



instructional course lectures, the american academy of orthopaedic surgeons - periprosthetic...

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