Abstract
Introduction: Periprosthetic fractures are a relatively common complication of total hip arthroplasty. Like other types of fractures, they occur when the bone is subjected to excessive force.
Specific reasons for the fracture include loosening of the prosthesis or osteoporotic changes in the bone. Perioperative fractures are usually caused by the effects of excessive force in processing of the bones or during implantation of the prosthesis, which happens more frequently with cementless prostheses.
Fractures that occur during implantation of the endoprosthesis are mostly banal fissures in the neck of the femur or trochanter, but occasionally there are fractures in the shaft, which require surgical treatment. The classifications used for these fractures are simple and unhelpfully self-serving.
The Vancouver classification was used to evaluate our cohort and it was subsequently modified according to the analysis of our group of intraoperative periprosthetic fractures. Methods and Results: We evaluated 53 fractures (2.7%) from the number of 1927 hip replacements in the period from 2008 to 2012.
From this number, there were 18 trochanter fractures (0.9%), 16 fissures of the neck not affecting the shaft of the femur (0.8%), 10 fractures in the calcaneum and diaphysis (0.5%) and 6 diaphysis fractures in the subprosthetic region (0.3 %). Also included in the group were three intraoperative acetabular fractures (0.2 %).
Treatment included osteosynthesis or replacement of the stem with a longer revision stem. Attention was paid to the occurrence and development of complications, especially in cases of fractures of the types B and C.
Discussion: By analysing the complications (the analysis included only loosening of osteosythesis or of the stem of the prosthesis), a proposal for classification of intraoperative fractures in the calcaneum and diaphysis (B and C) was developed, for 1) fractures with loosening of the stem and 2) shaft fractures with a stable implant.