Treatment of periprosthetic femoral fractures with the Bicontact revision stem.

PURPOSE

Periprosthetic fractures in cases without prior loosening of the stem can be treated with open reduction and internal fixation, but cases with preexisting loosening and/or bone defects present specific challenges to the surgeon. The keys to the success of intramedullary stabilization of femoral fractures--reconstruction of length, axis and rotation rather than meticulous reduction of the fragments and minimal impact on fragment vascularization by the surgical approach--can be transferred to the treatment of periprosthetic fractures.

METHOD

The Bicontact revision stem can be regarded as a combination of an interlocking nail in its distal part and a proximally coated femoral stem in its proximal part. The transfemoral approach respects the vascularization of the bone, although it is not minimally invasive. Forty-one patients with a mean age of 72.3 years and a periprosthetic fracture were included in this study. According to the Vancouver classification there were 2 type A fractures of the trochanteric region, 14 were B1, 8 were B2 with prior loosening, 13 were B3 with significant bone loss, and 2 fractures were distal to the tip of the prosthesis (type C).

RESULTS

In all patients, intramedullary stabilization with a Bicontact revision stem was performed. All but three fractures healed (pathologic fracture with multiple myeloma in one case, impaired bone healing in two cases). In 7 patients, further procedures had to be undertaken (new periprosthetic fracture in 2, loosening and revision with a standard prosthesis in 2, revision with a long stem prosthesis together with bone grafting in 3 cases). At follow-up, after a mean of 4.3 years, all patients were able to walk, and the mean Harris Hip Score was 71.1 points.

CONCLUSION

In conclusion, combined application of the principles of intramedullary nailing and of uncemented total hip replacement by use of the distally interlocked Bicontact revision stem enables successful treatment of periprosthetic femoral fractures.