SA Orthopaedic Journal
On-line version ISSN 2309-8309
Periprosthetic fractures following total hip or knee arthroplasty have become more common as the indications and age distribution for these procedures have increased in the last few years. Revision surgery in these patients holds a very high complication rate and therefore measures should be taken to prevent these fractures. Osteolysis with subsequent component loosening has been shown to pose a risk for periprosthetic fractures. Regular follow-up visits could reveal early signs and symptoms of component loosening. Patients who develop loosening should be revised as soon as possible to prevent periprosthetic fractures. The Vancouver classification (intra- and post-operative) for periprosthetic fractures associated with total hip replacement has been shown to be reproducible and an excellent guideline for management. Revision surgery for periprosthetic fractures carries a significant risk for complications. This review and instructional article will focus mainly on periprosthetic fractures in hip arthroplasty, although some risk factors and biomechanical considerations are also applicable for periprosthetic fractures of the femur in knee arthroplasty. Greater trochanteric fractures can present intra-operatively or post-operatively. Non-unions of the greater trochanter commonly presents many years down the line in patients where the surgical approach was done through greater trochanteric osteotomy, and are generally difficult to treat. This review will cover some aspects on the fixation methods of these fractures. Finally the hardware and surgical adjuncts to treat periprosthetic fractures will be discussed briefly. The more common fracture patterns (type B2) and the problematic (type B3) will be discussed in more detail.
Keywords : Periprosthetic fracture; hip; Vancouver classification; revision surgery; femur.