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Clinical Orthopaedics and Related Research®

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01-02-2014 | Symposium: 2013 Hip Society Proceedings

Periprosthetic Femur Fractures Treated With Modular Fluted, Tapered Stems

Authors: Matthew P. Abdel, MD, David G. Lewallen, MD, Daniel J. Berry, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 2/2014

Abstract

Background

Treatment of periprosthetic femur fractures is challenging, and high failure and complication rates have been reported in many series. The optimal techniques and implants for the management of Vancouver B2 and B3 fractures remain in debate.

Questions/purposes

The purpose of this study was to evaluate the results of a relatively new class of femoral implants, uncemented fluted, tapered, modular stems, to treat periprosthetic femur fractures; we specifically evaluated (1) fracture union; (2) implant stability; (3) patient outcomes; and (4) complications.

Methods

We retrospectively identified 44 Vancouver B2 (25 patients) and B3 (19 patients) periprosthetic femur fractures treated consecutively with fluted, tapered stems at a single institution from 2000 to 2006. The mean patient age was 72 years (range, 34–92 years), and 24 were women. The minimum followup was 2 years (mean, 4.5 years; range, 2–8 years).

Results

Forty-three of 44 (98%) fractures healed radiographically and 43 of 44 (98%) femoral components were stable radiographically at latest followup. The mean postoperative Harris hip score was 83. There were seven additional reoperations (five for recurrent instability, two for deep infections).

Conclusions

Modular fluted, tapered stems provide a reliable treatment method for Vancouver B2 and B3 periprosthetic femoral fractures with a high rate of fracture union and implant osteointegration. The most common complication, instability, may be reduced by more consistent use of larger femoral head diameters.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Australian Orthopaedic Association National Joint Replacement Registry. 2010 Annual Report. Adelaide, Australia: AOA; 2010.

Beals RK, Tower SS. Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res. 1996;327:238–246.PubMedCrossRef

Berry DJ. Total hip arthroplasty in patients with proximal femoral deformity. Clin Orthop Relat Res. 1999;369:262–272.PubMedCrossRef

Berry DJ. Treatment of Vancouver B3 periprosthetic femur fractures with a fluted tapered stem. Clin Orthop Relat Res. 2003;417:224–231.PubMed

Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91:128–133.PubMedCrossRef

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

Garbuz DS, Masri BA, Duncan CP. Periprosthetic fractures of the femur: principles of prevention and management. Instr Course Lect. 1998;47:237–242.PubMed

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMed

Kaplan E, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.CrossRef

10.

Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.PubMedCrossRef

11.

Kwong LM, Miller AJ, Lubinus P. A modular distal fixation option for proximal bone loss in revision total hip arthroplasty: a 2- to 6-year follow-up study. J Arthroplasty. 2003;18:94–97.PubMedCrossRef

12.

Lindahl H, Garellick G, Regner H, Herberts P, Malchau H. Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am. 2006;88:1215–1222.PubMedCrossRef

13.

Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty. 2005;20:857–865.PubMedCrossRef

14.

McInnis DP, Horne G, Devane PA. Femoral revision with a fluted, tapered, modular stem seventy patients followed for a mean of 3.9 years. J Arthroplasty. 2006;21:372–380.PubMedCrossRef

15.

Mulay S, Hassan T, Birtwistle S, Power R. Management of types B2 and B3 femoral periprosthetic fractures by a tapered, fluted, and distally fixed stem. J Arthroplasty. 2005;20:751–756.PubMedCrossRef

16.

Park MS, Lim YJ, Chung WC, Ham DH, Lee SH. Management of periprosthetic femur fractures treated with distal fixation using a modular femoral stem using an anterolateral approach. J Arthroplasty. 2009;24:1270–1276.PubMedCrossRef

17.

Rodriguez JA, Fada R, Murphy SB, Rasquinha VJ, Ranawat CS. Two-year to five-year follow-up of femoral defects in femoral revision treated with the link MP modular stem. J Arthroplasty. 2009;24:751–758.PubMedCrossRef

18.

Schuh A, Werber S, Holzwarth U, Zeiler G. Cementless modular hip revision arthroplasty using the MRP Titan Revision Stem: outcome of 79 hips after an average of 4 years’ follow-up. Arch Orthop Trauma Surg. 2004;124:306–309.PubMedCrossRef

19.

Springer BD, Berry DJ, Lewallen DG. Treatment of periprosthetic femoral fractures following total hip arthroplasty with femoral component revision. J Bone Joint Surg Am. 2003;85:2156–2162.PubMed

20.

Tamvakopoulos GS, Servant CT, Clark G, Ivory JP. Medium-term follow-up series using a modular distal fixation prosthesis to address proximal femoral bone deficiency in revision total hip arthroplasty. A 5- to 9-year follow-up study. Hip Int. 2007;17:143–149.PubMed

21.

Weiss RJ, Beckman MO, Enocson A, Schmalholz A, Stark A. Minimum 5-year follow-up of a cementless, modular, tapered stem in hip revision arthroplasty. J Arthroplasty. 2011;26:16–23.PubMedCrossRef

22.

Wirtz DC, Heller KD, Holzwarth U, Siebert C, Pitto RP, Zeiler G, Blencke BA, Forst R. A modular femoral implant for uncemented stem revision in THR. Int Orthop. 2000;24:134–138.PubMedCentralPubMedCrossRef

Title: Periprosthetic Femur Fractures Treated With Modular Fluted, Tapered Stems
Authors: Matthew P. Abdel, MD
David G. Lewallen, MD
Daniel J. Berry, MD
Publication date: 01-02-2014
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 2/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-2936-4

At a glance: The STEP trials

Springer Medicine

Periprosthetic Femur Fractures Treated With Modular Fluted, Tapered Stems

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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