Background: A periprosthetic fracture around the femoral component
is a rare but potentially problematic complication after total hip
arthroplasty. Reconstruction can be challenging, especially when severe bone
stock deficiency is encountered. Proximal femoral replacement is one method of
treating the severely deficient proximal part of the femur. The present report
describes the outcomes of revision total hip arthroplasty with use of a
proximal femoral replacement in a cohort of patients who had a Vancouver
type-B3 periprosthetic fracture.
Methods: With use of a computerized institutional database, all
patients in whom a Vancouver type-B3 fracture (characterized by severe
proximal bone deficiency and a loose femoral stem) had been treated with a
proximal femoral replacement were identified. A modular femoral replacement
with proximal porous coating had been used in all cases. The twenty-one
patients who were identified had had a mean age of 78.3 years (range,
fifty-two to ninety years) at the time of the index operation. The clinical
and radiographic records of these patients were reviewed.
Results: At the time of the latest follow-up (mean, 3.2 years), all
but one of the patients were able to walk and had minimal to no pain.
Complications included persistent wound drainage that was treated with
incision and drainage (two hips), dislocation (two hips), refracture of the
femur distal to the stem (one hip), and acetabular cage failure (one hip).
Conclusions: Despite a relatively high complication rate, we believe
that proximal femoral replacement is a viable option for the treatment of
periprosthetic fractures in older patients with severe bone deficiency. If a
proximal femoral replacement is used, the stability of the hip must be tested
diligently intraoperatively and a constrained acetabular liner should be
utilized if instability is encountered. In order to enhance the bone stock,
the proximal part of the femur, however poor in quality, should be retained
for reapproximation onto the implant.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.