Convened under the auspicious of esteemed endorsers - ISTA

Thursday, October 7, 2010, 16:30-17:20Session A8: Periprosthetic Fractures in THAThe Evidence Based Approach Towards Management of PeriprostheticFractures Around the Hip.Bhupinder Mann - RNOH, Stanmore, UK - London, UK*Ahsan Sheeraz - Royal National Orthopaedic Hospital, Stanmore - London, UKRachel Shaw - Nottingham University - Nottingham, UKGovin Murugachandran - Whittington Hospital - London, UKRatukondla Ravikumar - North Middlesex Hospital - London, UKINTRODUCTION:*Email: ahsanshiraz@hotmail.comThe number of patients undergoing total hip replacement surgery is rising and thus the numberof periprosthetic fractures is set to increase. The risk factors for periprosthetic fractures includeosteolysis, rheumatoid arthritis, osteoporosis and use of certain types of implants. Evidencefrom literature suggests that the mortality rate within one year is similar to that followingtreatment for hip fractures thus as surgeons it is important for us to understand the variousmanagement strategies of these fractures.MANAGEMENT:Acetabular periprosthetic fractures are uncommon and classified into Type I, in which theacetabular component is radiographically stable and Type II, in which the acetabular componentis unstable. It is better to prevent than to treat these fractures.Femoral periprosthetic fractures have several classifications the most commonly used is theVancouver classification (fig 1).Type-A fractures are proximal and can involve the greater or lesser trochanter. These are oftenrelated to osteolytic wear debris and therefore revision of the bearing surface with bone graftingis recommended. AG involves the greater trochanter and A L involves the lesser, and these canusually be stabilised by cerclage wires supplemented by screws or plates if required (fig 2).Management of type B fractures is more controversial and will be discussed in depth withreference to all recent papers at the meeting and data from the Swedish Joint Registry. Insummary the management is shown in fig 3.In type-C fractures, one should ensure the fixation device bypasses the femoral stem by at least2 diaphyseal diameters. Management is as shown in fig 4.DISCUSSION:file:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]