Management of periprosthetic fractures around cemented femoral stems: osteosynthesis and revision strategies

Periprosthetic femur fractures most often occur in elderly, frail patients and represent a devastating injury with high rates of morbidity and mortality even with appropriate surgical management. Hip arthroplasties with cemented femoral fixation have a decreased risk of periprosthetic fracture relative to cementless designs, especially when composite beam stems are used compared to polished, taper-slip stems. Early mobilization is the primary goal of treatment for periprosthetic femur fractures, which can be achieved either through open reduction internal fixation or through revision arthroplasty. Where the pattern is reconstructable, such as in most B1 patterns and some B2 fractures around polished, taper-slip stems, open reduction internal fixation of fractures around cemented stems has been associated with decreased perioperative complications compared to revision arthroplasty. In the setting of a compromised bone-cement interface, inadequate metaphyseal bone stock, or implant breakage, revision arthroplasty is the preferred treatment strategy.