To Analyze the Outcomes of Various Methods of Treatment of Periprosthetic Fracture Following Hip Arthroplasty- A Retrospective Study to Form the Optimal Treatment Guidelines

Background: Periprosthetic fracture of femur after total hip arthroplasty (THA) is a well-known complication. Mayo clinic joint registry has reported 1.1% incidence of periprosthetic femoral fractures after primary THA and 4% incidence after revision THA. This study was conducted to analyse the results of various methods of treatment of periprosthetic fractures following THA and to form the optimal treatment guidelines for fixation or revision surgeries. Material and Methods: Out of 4790 primary hip arthroplasty cases, a total of 51 fractures in 48 patients were enrolled. The previous records and radiographs of the patients were retrieved and the type of periprosthetic fracture classified according to Vancouver classification developed by Duncan and Masri. Sequential x-rays of the hip were taken to assess union, osteolysis, implant loosening and subsidence. The time to union was recorded. Results: Vancouver Type B1 and type C fractures, managed with open reduction and internal fixation (ORIF) using 4.5mm, titanium, broad, locking compression plate (LCP) system. All the fractures of Vancouver B2 and B3 Type were managed with revision total hip arthroplasty using standard posterior approach to the hip. There was no increment seen in the pre-op and post-op HHS in Type B1 & C fractures. An increase in post-op HHS values was seen in revision group which increased around 6 points in B2 fractures and 9 points in B3 fractures. None of the patients improved their ability of walking after these fractures. 23 patients (48%) had not regained their pre-fracture walking status at the 6-month follow-up. Conclusion: If the prosthesis is stable, osteosynthesis with long LCP plate is superior to conventional plate. For loose prosthesis, revision surgery with long uncemented distally fitting stem is the preferred treatment.