Surgical Treatment of Periprosthetic Fractures After Total Hip Replacement

Periprosthetic proximal femoral fractures after total hip replacement can be difficult to manage and may have a high complication rate. This title describes a surgical technique that splits the entire proximal segment above the fracture with an extended lateral osteotomy. It explains the issues surrounding this surgical technique.

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This title focuses on such areas as: joint replacement and hip, knee & lower extremity. Periprosthetic proximal femoral fractures after total hip replacement can be difficult to manage and may have a high complication rate. Duncan/Masri B2 and B3 fractures occur at the lower end of the femoral component and are associated with femoral implant loosening and bone osteolysis. Revision is usually required and long-term bone atrophy and osteolysis may compromise fracture union. Dr. Stiehl describes and demonstrates a surgical technique that splits the entire proximal segment above the fracture with an extended lateral osteotomy. Cerclage wiring allows the distal fragment to withstand the hoop stresses of tight distal implant fixation. A modular taper-fluted femoral modular component is inserted into this distal fragment and assembled to span the gap of the proximal bone loss. The proximal femur fracture is then cable-wired around the proximal prosthesis, and defects are supplemented with strut allografts. Recommendations for postoperative management typically include nonweightbearing for 10 to 12 weeks followed by protected weightbearing until ambulating independently. Dr. Stiehl explains the issues surrounding this surgical technique while the video clearly depicts the details of the approach. This includes exposure of the fracture, extended osteotomy, distal canal preparation, modular implant assembly, and final bone and soft tissue reconstruction.