Treatment of periprosthetic femoral fractures with distal fixation modular revision stems

Background Late periprosthetic fractures of the femur are the third most frequently reported cause of surgery after total hip artroplasty. Revision total hip artroplasty can be difficult, especially when poor bone stock is encountered. The aim of this study was to examine the results of late periprosthetic fractures complicated with primary implant loosening performed with distal fixation modular revision stem. Methods From November 1999 to May 2006, 16 late periprosthetic fractures were treated with distal-fixation, modular, straight stem. There were 13 females (82%) and 3 males (18%) whose mean age at surgery was 76.7 years (range, 48 to 95 years). Femoral revision surgery was performed with the Revitan (2 cases) and ZMR (14 cases) to get a stable distal primary fixation. X-rays were assessed accordingly to the Vancouver classification: there were 3 type B2 and 13 type B3 fractures. Mean post-operative follow-up was 52 months (range, 10 to 88 months). At the time of the last follow-up visit 4 patients already passed away, all of them for causes unrelated to the procedure. The clinical outcome was monitored with the Harris Hip Score, subjective VAS, pain and satisfaction evaluation. Standard AP and lateral x-rays of the hip were obtained at each follow-up visit. Leg-length discrepancy was also investigated as a factor possibly affecting outcome. Complications included one septic loosening that was treated with a two-stage revision. Results All the patients but one were finally able to walk and had minimal to no pain at all. A satisfactory functional outcome was achieved with an average 76 (range, 25 to 100) Harris Hip Scores points. The subjective pain and satisfaction scores were respectively 2.4 and 7.8 points. As far as radiograms are concerned, all the sixteen femur did show a good healing of the fracture, with no secondary stem subsidence. Discussion Generally, considering the severity of an event such as a periprosthetic late fracture in an elderly patient, results were satisfactory. The average Harris Hip Score and subjective satisfaction would have been even higher if one patient wouldn’t have been so much disappointed because of her severe leg-length discrepancy, dependent on the acetabular side. From a surgical point of view, the employed devices proved to be handy in bridging the fracture with distal fixation while adequately stabilizing it. Conclusions According to the reported results, straight modular-revison stems provide an adequate treatment option of Vancouver type B3 and in selected cases of B2 type periprosthetic femoral fracture.