Periprosthetic fractures and complicated arthroplasties

Excerpt

Periprosthetic fractures (PPF) have become a frequent complication of total hip and knee replacements with rates up to 15 % in major registries. Other artificial articulations such as the shoulder and the elbow, although less frequently concerned, are not immune to this complication. This observation is related to the increased number of procedures performed annually, with projection showing that the growth will continue exponentially in the next decades due to aging population. The number of revision procedures increases also with the associated bone loss, that is a major risk factor for PPF, and that will probably continue to rise. It is probable that this complication will become in the near future a major public health issue with high rising costs associated to the treatment. It becomes therefore evident that surgeons should be aware of PPF and complicated revisions to advise the patients accordingly, making this special issue of International Orthopaedics necessary. We have put together a sum of papers concerning the subject from around the world and from major experts. There are papers on the biomechanics and stability of the revision stems [1, 2] , as it is important for surgeons to understand how this complication can occur, and hence how to avoid conditions that would lead to PFF, especially stress risers. Periprosthetic fractures around the hip and the knee are extensively described with up to date detailed treatment options, from various fixation modes of well fixed implants to revision. A specific situation is studied by Zettl et al. [3] concerning the acetabular fractures in the elderly with a description of a minimally invasive technique in this patient population with co-morbid conditions. A very interesting paper coming from China (Huang and coll) proposes variations and adds to the existing classifications [4]. Tatu Makkinen from Finland and Canada brings an original biomechanical study comparing four methods of fixation after periprosthetic supracondylar fractures of the femur after knee arthroplasty [5]. Claudia Sidler-Maier and James Wadell from Canada bring a thorough literature review and discuss the current state of the art in this field of treating complications and traumatic events on fragile prosthetic joints [6]. Märdian and colleagues discuss the outcomes after PPF around the hip [7]. Baba Tomonori from Japan discusses his own classification and its inter-observer variability [8] while Yassem and Haddad [9] as well as the next three papers coming from South-Korea [10], Sweden [11] and France [12] discuss different aspects related to PPF in femur. The paper from Barut et al. [13] provide insights of PPF around tumor prosthesis, as this situation adds to the complexity of the fractures associated to mega- or composite implants, a previous resection procedure, making internal fixation attractive but with high risk of revision. As a reader you may find useful the paper authored by Schmolders and coll. [14] concerning the value of the Charlson comorbidity index in the assessment of revision surgeries. The Romanian team from Tg. Mures is bringing a paper about complicated acetabular reconstructions in protrusions [15]. There are also some invited papers that arrived late or too late for being included in this issue. They will be available online and in the printed issues of October and November. …