Reilly R. Kuehn


Periprosthetic fractures of the femur after total hip arthroplasty (THA) and hemiarthroplasty represent relatively uncommon but challenging complications. The incidence of these types of fractures has been rising, owing to an increasing number of hip arthroplasties performed, aging population, and prevalent use of uncemented stems, which may have unsuccessful long-term results compared with use of cemented stems. Method of treatment has been generally based on the Vancouver classification system that describes radiographic characteristics of fractures and stability of the femoral stems in respect to placement in the bone. In particular, the presence of loose stems has often indicated the need for revision THA; on the other hand, fractures located around and distal to well-fixed stems typically have been treated with open reduction and internal fixation (ORIF). The failure to preoperatively identify loose stems may result in unsuccessful treatment with ORIF. I reviewed clinical evaluation, mortality rates, and treatment of patients with Vancouver types A, B1, B2, B3, and C periprosthetic femur fractures. Appropriate treatment of these challenging injuries requires highlevel surgical technique, ranging from use of biologicallyfriendly methods to performing complex revision THA.

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Orthopedics Commons



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