Periprosthetic fractures are fractures that occur near the implanted artificial prosthesis after total hip arthroplasty. The type of fracture is usually more severe, complex and requires surgical management. Most periprosthetic fractures occur several years after hip arthroplasty. After joint replacement, the patient has recovered well from function and the fracture was caused by accidental violence such as a fall. Periprosthetic fractures are a big challenge for the joint surgeon because the patient who develops the fracture is usually elderly, with severe fracture laxity and with other underlying disease.
Location: Most periprosthetic fractures occur in the trochanteric portion of the femur, with fractures in the acetabular portion being relatively rare.
Causes: Falls are the most common cause of periprosthetic fractures. They can also be caused by high-energy injuries, such as direct blows with a stick or impact with a vehicle. The type and severity of the fracture depends on the quality of the bone and the amount of energy used to cause the fracture; in addition, people with decreased muscle strength, decreased vision, or poor balance are at increased risk for fracture. In particular, it is important to emphasize that the danger of fracture laxity is very obvious, on the one hand making the bone less strong, and at the same time it can lead to loosening of the prosthesis. A loose femoral stem prosthesis is also a major risk factor, and this loosening may be present for a long time, and with the patient’s daily activity, it can lead to osteolysis and consequently to a thinning of the cortex at the end of the femur.
Symptoms.
1. sudden onset of pain around the hip or thigh.
2. swelling around the thigh or hip.
3. inability of the patient to bear weight on the affected limb.
4, shortening or deformation of the affected limb.
Examination: pelvic plain film, front and side hip film, and full-length femur film will show the location, type and complexity of the fracture.
In some special cases, especially the fracture on the acetabular side, we need to do 3D CT to clarify the fracture and make adequate preoperative preparation.
Treatment: All require surgical treatment, and the surgical plan needs to be developed by considering factors such as the site and type of fracture, whether the prosthesis is loose, and the patient’s bone strength and general health condition. Patients are usually hospitalized for a week prior to surgery to receive basic treatment, with the goal of minimizing the risks of surgery.
Surgical methods.
1, incisional repositioning internal fixation, according to the injury, surgical conditions and operation level, try to choose minimally invasive surgery and minimize the incidence of surgical anesthesia accidents.
2, partial or total hip revision, applicable when the fracture spreads to the prosthesis and causes instability of the prosthesis.
3, combination of both.
Complications or accidents of surgery.
1, infection.
2, deep vein thrombosis.
3, fracture displacement.
4, Inequality of both lower extremities.
5. non-healing of the fracture.
6, re-fracture.
7, no bone growth into the new shank.
8. In some complex cases of periprosthetic fractures, multiple surgeries may be required to correct secondary complications, so thorough preoperative communication with the patient is required to inform of the possibilities.
Some patients may also need to wear a brace for several weeks to protect the affected limb, and the rehabilitator will guide the patient through this process for safe and effective rehabilitation. It can take several months from discharge to normal ambulation, and after discharge, patients can receive specialized instruction in a rehabilitation center or nursing center to better and more quickly restore muscle strength and promote bone healing. Anti-osteoporosis treatment is very important in the later stages.