periprosthetic fractures
TRANSCRIPT
1
Evaluation results of surgical treatment of periprosthetic femoral fractures of THA in years 2004-2010
Martin KorbelOrtopedická klinika FN Hradec Králové
Incidence 0,4 – 6 %
increase in revision surgeries obese patiens (BMI over 35) elderly patients with fragile bones in cementless total hip arthoplasties
Vancouver classification
- location of the fracture- fixation of the stem- quality of the remaining bone stock
Vancouver A
fractures involve the greater or lesser trochanter
stable conservative treatment (protected weight bearing)
unstable trochanteric cerclage
Vancouver B
around or just distal to stem surgical treatment
B1 – the stem remains well fixed
open reduction and internal fixation
B2 – the stem is loose long stem revision, cerclage
B3 – the stem is loose and the proximal femur is
deficientlong stem revision, cerclage
Vancouver C
below the stem with no stem loosening
open reduction and internal fixation leaving the stem
Methodics
periprosthetic fractures 47patients 40, men 18, women 22
2004
5
2005
7
2006
4
2007
7
2008
9
2009
8
2010
7
0123456789
2004 2005 2006 2007 2008 2009 2010
Methodics
average time from total hip arthroplasty 7 years and 3 months
Vancouver A 2
Vancouver B1 3
Vancouver B2 27
Vancouver B3 7
Vancouver C 8
cemented prosthesis
20
cementless prosthesis
23
hybrid prosthesis 4
intraoperative fractures
3
Comorbidity 4 condition after stroke 3 Parkinson´s disease 2 Bechterew´s disease 3 condition after peripheral nerve paresis 1 alcoholism
10
* 11 years after implantation------------------------* walking the walking stick* no pain* F 90* A 30* IR 10* ER 20
11
* 4 years after implantation
----------------------* walk without support * no pain* F 90* A 30* IR 10* ER 20
12
* 2 months after implantation------------------------------* complicated by pulmonary
embolism * walk without support * no pain* F 110* A 40* IR 10* ER 30
13
* conditoin after stroke with right-sided hemiparesis
* 7 years after implantation* complicated by hemorrhagic shock
* walking in walker * no pain* F 80* A 25* IR 10* ER 10
14
* 12 years after implantation
------------------------* walking without support* no pain* F 90* A 20* IR 10* ER 10
15
* 2 years after implantation-----------------------* walking the walking stick* no pain* F 90* A 30* VR 10* ZR 10
Vancouver A (2)
16
2 trochanteric cerclage
Treatment results no pain 2 walking the walking stick F 100, A 30, IR 10, ER 15 no complication
17
Vancouver B1 (3) 3 open reduction and internal fixation
Treatment results 1 walking without support 2 walking the walking stick F 80, A 25, IR 5, ER 10 1 fracture plate osteosynthesis, 1 superficial infection
18
Vancouver B2 (27) 17 long stem revision + cerclage 9 open reduction and internal fixation (4 long fracture
excess revision stem length, 3 condition after long stem revision)
1 extension (sepsis)
Treatment results 2 persistent mild pain 5 walking without support 18 walking the walking stick 5 walking in walker F 74, A 25, IR 10, ER 12 4 fracture plate osteosynthesis, 1 fracture of the
femoral stem, 2 luxation, 3 femoral nerve palsy, 2 deep infection, 2 hemorrhagic shock, 1 stroke, 1 pulmonary embolism
19
Vancouver B3 (7)
2 long stem revision + cerclage 3 tumor stem revision 2 extension
Treatment results no pain 1 walking without support 4 walking the walking stick 2 walking in walker F 75, A 20, IR 10, ER 12 1 superficial infection
20
Vancouver C (8)
7 open reduction and internal fixation
Treatment results 1 persistent mild pain 3 walking without support 2 walking the walking stick 2 walking in walker F 88, A 30, IR 15, ER 15 no complication
21
Conclusion
large number of patients with diseases of the nervous or musculoskeletal system
generally poor results with a large number of complications in the group of Vancouver B2 fractures
Vancouver B2 fractures treated with the implantation of the revision stems and cerclage