Top

International Orthopaedics

Published in:

01-07-2021 | Periprosthetic Fracture | Original Paper

Comparison of different fixation techniques for periprosthetic fractures: a biomechanical study of a new implant

Authors: Mehmet Nuri Konya, Ugur Yuzuguldu, Recep Altin, Ugur Fidan

Published in: International Orthopaedics | Issue 7/2021

Abstract

Introduction

The ideal treatment method for periprosthetic fractures is controversial due to the risks of current methods. Single-cortex screw fixation in prosthesis may lead to implant failure. Therefore, we aimed to develop an implant that lowers the risk for complications. For this study, we designed and tested two new implant models. The first model was a plate with a combination of U nails and cerclage holes. The second model was a U nail plate with a screw, which combines a plate screw with U nail (staples). Our study aimed to compare the stability of two newly designed implants with classical treatment modalities. We used 27 (in 3 groups) artificial bone models and 9 different test models.

Methods

The ISO 7206-4:2010 (E) standards were used for 27 bones in nine groups tested under laboratory conditions. In our study, we examined nine different groups. In group 1, hip the prosthesis was extracted, and a revision femoral stem was embedded. In group 2, periprosthetic fractures were repaired with a plate and cable. In group 3, periprosthetic fractures were repaired with a plate and stapler. In group 4, periprosthetic fractures were repaired with a plate and stapler cable. In group 5, periprosthetic fractures were repaired with a plate stapler and screw. Groups 6 and 7 were the control groups. Group 6 was the only artificial bone group, and group 7 was the prosthesis embedded bone group. Group 8 was periprosthetic fractures treated with unicortical screw fixation with cerclage, and group 9 was periprosthetic fractures treated with unicortical screw fixation. Axial loading was applied to the bones. The yield strength of the system was determined by loading the synthetic bone models with a constant compression speed of 5 mm/min through the centre of motion using the Geratech SH 2000 testing system. During the tests, load and displacement values were recorded, and the stiffness of the models was calculated based on those values.

Results

According to our results, the greatest durability was found in the revision hip prosthesis group (1511 N), and the weakest performance was found in the plate with the stapler implant group (163N). When comparing the data of groups according to compression, significant differences were found in group 2 with groups 1, 4, 5, and 7; group 3 with group 1; group 8 with groups 1 and 5; and group 9 with 1, 5, 7, and according to breakage, significant differences were found in group2 with groups 1, 3, 5, and 7; group 3 with group 1; group 8 with groups 1 and 5; and group 9 with groups 1, 5, and 7 (p<0.001).

Discussion

The revision hip prosthesis treatment for periprosthetic fractures showed the best performance, followed by the plate with stapler screw. In older patients, U nail-augmented implants may be a good alternative for periprosthetic fractures. Unicortical screw and cerclage wire combination fixation results were unsatisfactory results in this study.

Conclusion

This is an experimental study, so further studies, especially patient-specific studies, should be made to expand the findings of this study.

Available only for authorised users

Hoffmann MF, Burgers TA, Mason JJ, Williams BO, Sietsema DL, Jones CB (2014) Biomechanical evaluation of fracture fixation constructs using a variable-angle locked periprosthetic femur plate system. Injury 45:1035–1041. https://doi.org/10.1016/j.injury.2014.02.038CrossRefPubMed

Fleischman AN, Chen AF (2015) Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls. Ann Transl Med 3:234. https://doi.org/10.3978/j.issn.2305-5839.2015.09CrossRefPubMedPubMedCentral

Mäkelä KT, Matilainen M, Pulkkinen P, Fenstad AM, Havelin LI, Engesaeter L, Furnes O, Overgaard S, Pedersen AB, Kärrholm J, Malchau H, Garellick G, Ranstam J, Eskelinen A (2014) Countrywise results of total hip replacement. An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database. Acta orthopaedica 85(2):107–116. https://doi.org/10.3109/17453674.2014.893498

Legosz P, Platek AE, Rys-Czaporowska A, Szymanski FM, Maldyk P (2019) Correlations between Vancouver type of periprosthetic femur fracture and treatment outcomes. J Orthop 16:517–521. https://doi.org/10.1016/j.jor.2019.05.011CrossRefPubMedPubMedCentral

Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304PubMed

Davidson D, Pike J, Garbuz D, Duncan CPCP, Masri BABA (2008) Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am 90:2000–2012. https://doi.org/10.2106/JBJS.H.00331CrossRefPubMed

Zdero R, Walker R, Waddell JPJP, Schemitsch EHEH (2008) Biomechanical evaluation of periprosthetic femoral fracture fixation. J Bone Joint Surg Am 90:1068–1077. https://doi.org/10.2106/JBJS.F.01561CrossRefPubMed

Schmidt AH (2018) Problems in plating periprosthetic femur fractures. Injury 49:S49–S50CrossRef

Hoffmann MF, Jones CB, Sietsema DL, Koenig SJ, Tornetta P (2012) Outcome of periprosthetic distal femoral fractures following knee arthroplasty. Injury 43:1084–1089. https://doi.org/10.1016/j.injury.2012.01CrossRefPubMed

10.

Wang K, Kenanidis E, Miodownik M, Tsiridis E, Moazen M (2019) Periprosthetic fracture fixation of the femur following total hip arthroplasty: a review of biomechanical testing - Part II. Clin Biomech 61:144–162. https://doi.org/10.1016/j.clinbiomech.2018.12.001CrossRef

11.

Siamos G, Winkler S, Boberick KG (2002) Relationship between implant preload and screw loosening on implant-supported prostheses. J Oral Implantol 28:67–73. https://doi.org/10.1563/1548-1336(2002)028<0067:TRBIPA>2.3.CO;2CrossRefPubMed

12.

Gaski GE, Scully SP (2011) In brief: classifications in brief: Vancouver vancouver classification of postoperative periprosthetic femur fractures. Clin Orthop Relat Res 469:1507–1510. https://doi.org/10.1007/s11999-010-1532-0CrossRefPubMed

13.

Iesaka K, Kummer FJ, Di Cesare PE (2005) Stress risers between two ipsilateral intramedullary stems: a finite-element and biomechanical analysis. J Arthroplast 20:386–391. https://doi.org/10.1016/j.arth.2004.05.002CrossRef

14.

Lehmann W, Rupprecht M, Nuechtern J, Melzner D, Sellenschloh K, Kolb J, Fensky F, Hoffmann M, Püschel K, Morlock M, Rueger JM (2012) What is the risk of stress risers for interprosthetic fractures of the femur? A biomechanical analysis. Int Orthop 36:2441–2446. https://doi.org/10.1007/s00264-012-1697-0CrossRefPubMedPubMedCentral

15.

Hoffmann MF, Lotzien S, Schildhauer TA (2017) Outcome of periprosthetic femoral fractures following total hip replacement treated with polyaxial locking plate. Eur J Orthop Surg Traumatol 27:107–112. https://doi.org/10.1007/s00590-016-1851-2CrossRefPubMed

16.

Dennis MG, Simon JA, Kummer FJ, Koval KJ, DiCesare PE (2000) Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques. J Arthroplast 15:523–528. https://doi.org/10.1054/arth.2000.4339CrossRef

17.

Lever JP, Zdero R, Nousiainen MT, Waddell JP, Schemitsch EH (2010) The biomechanical analysis of three plating fixation systems for periprosthetic femoral fracture near the tip of a total hip arthroplasty. J Orthop Surg Res 5:45. https://doi.org/10.1186/1749-799X-5-45CrossRefPubMedPubMedCentral

18.

Wu JC, Mills A, Grant KD, Wiater PJ (2019) Fracture fixation using shape-memory (Ninitol)staples. Orthop Clin North Am 50:367–374. https://doi.org/10.1016/j.ocl.2019.02.002CrossRefPubMed

19.

Yang PJ, Zhang YF, Ge MZ, Cai TD, Tao JC, Yang HP (1987) Internal fixation with Ni-Ti shape memory alloy compressive staples in orthopedic surgery. A review of 51 cases. Chin Med J 100:712–714PubMed

20.

Hoon QJ, Pelletier MH, Christou C, Johnson KA, Walsh WR (2016) Biomechanical evaluation of shape-memory alloy staples for internal fixation-an in vitro study. J Exp Orthop 3:19. https://doi.org/10.1186/s40634-016-0055-3CrossRefPubMedPubMedCentral

21.

Konya MN, Korkusuz F, Altin R, Maralcan G, Demir T (2021) Femur periprostetik kirik tedavisinde yeni tasarlanmiş u çivili plağin etkinliliği; karşilaştirmali biyomekanik çalişma. Kocatepe Tıp Dergisi 22:50–56. https://doi.org/10.18229/kocatepetip.699882CrossRef

Title: Comparison of different fixation techniques for periprosthetic fractures: a biomechanical study of a new implant
Authors: Mehmet Nuri Konya
Ugur Yuzuguldu
Recep Altin
Ugur Fidan
Publication date: 01-07-2021
Publisher: Springer Berlin Heidelberg
Keyword: Periprosthetic Fracture
Published in: International Orthopaedics / Issue 7/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-021-05028-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Comparison of different fixation techniques for periprosthetic fractures: a biomechanical study of a new implant

Abstract

Introduction

Methods

Results

Discussion

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Discussion

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2021

Comparative prospective randomized study of minimally invasive transpiriformis approach versus conventional posterolateral approach in total hip arthroplasty as measured by biology markers

Comparison of the accuracy of the cup position and orientation in total hip arthroplasty for osteoarthritis secondary to developmental dysplasia of the hip between the Mako robotic arm-assisted system and computed tomography-based navigation

Clinical impact of intraoperative cone beam tomography and navigation for displaced acetabular fractures: a comparative study at medium-term follow-up

Low complication rate and better results for intramedullary nail - arthrodesis for infected knee joints compared to external fixator—a series of one hundred fifty two patients

Leukocyte esterase test and alpha-defensin test have similar accuracy for the diagnosis of periprosthetic joint infection

Radiographic parameter(s) influencing functional outcomes following angular stable plate fixation of proximal humeral fractures