Medical University of Vienna, Department of Trauma Surgery, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Injury. 2011 Nov;42(11):1219-25. doi: 10.1016/j.injury.2010.08.020. Epub 2010 Dec 21.
Interprosthetic femoral fractures following ipsilateral hip and knee arthroplasty are a rare but serious complication in clinical practice. In most cases, adequate management of these injuries might constitute a challenging problem. However, the literature provides only few data regarding the treatment and outcome of interprosthetic femoral fractures, and there are only few classifications available, which might assist in finding an appropriate treatment concept. The purpose of this study was to analyse our experience in the management of interprosthetic femoral fractures following ipsilateral hip and knee joint replacement.
We reviewed the clinical and radiographic records of 23 patients (15 female and eight male, average age: 79.2 years) with an interprosthetic fracture after ipsilateral hip and knee joint replacement between 1992 and 2008. For the classification of interprosthetic femoral fractures, the fractures were divided into three types, depending on the fracture site and the adjacency to the prostheses. All patients underwent operative stabilisation, either by lateral plate fixation (n=19), by revision arthroplasty using a long stem (n=2) or by plate fixation and revision arthroplasty (n=2).
Referring to the clinical outcome, 16 patients returned to their pre-injury activity level and were satisfied with their clinical outcome. In six patients, we saw a relevant decrease of hip or knee function and severe limitations in gait and activities of daily living. We had a mean Harris Hip Score (HHS) of 78.4 points, and a mean Knee injury and Osteoarthritis Outcome Score (KOOS) of 71.8 points. Relating to the radiographic outcome, successful fracture healing was achieved in 19 of 22 patients (86%) within 6 months. Failures of reduction and fixation were noted in four (18%) of 22 patients.
We had a satisfactory outcome following individualised treatment of interprosthetic femoral fractures following ipsilateral hip and knee joint replacement. Compared to the rare data in current literature, we had promising functional result and high rate of bony fusion. Regarding the complexity and challenges in many of these cases, interprosthetic fractures require an adequate analysis of the fracture aetiology and a suitable transfer into the best possible treatment concept.
同侧髋关节和膝关节置换术后发生的假体间股骨骨折是临床实践中一种罕见但严重的并发症。在大多数情况下，这些损伤的充分处理可能构成一个具有挑战性的问题。然而，文献中关于假体间股骨骨折的治疗和结果仅有很少的数据，并且只有少数分类可用，这可能有助于找到合适的治疗概念。本研究的目的是分析我们在同侧髋关节和膝关节置换术后假体间股骨骨折治疗方面的经验。
我们回顾了 1992 年至 2008 年间同侧髋关节和膝关节置换术后发生假体间骨折的 23 例患者（15 例女性，8 例男性，平均年龄：79.2 岁）的临床和影像学记录。为了对假体间股骨骨折进行分类，根据骨折部位和与假体的毗邻关系，将骨折分为三型。所有患者均接受手术固定，其中 19 例采用外侧钢板固定，2 例采用长柄翻修关节置换，2 例采用钢板固定和翻修关节置换。
参考临床结果，16 例患者恢复到受伤前的活动水平，并对其临床结果感到满意。6 例患者髋关节或膝关节功能明显下降，步态和日常生活活动严重受限。我们的 Harris 髋关节评分（HHS）平均为 78.4 分，膝关节损伤和骨关节炎结果评分（KOOS）平均为 71.8 分。参考影像学结果，22 例患者中有 19 例（86%）在 6 个月内骨折愈合良好。22 例患者中有 4 例（18%）出现复位和固定失败。
我们对同侧髋关节和膝关节置换术后假体间股骨骨折进行个体化治疗后取得了满意的结果。与当前文献中罕见的数据相比，我们获得了有希望的功能结果和高骨融合率。鉴于这些病例中的许多病例的复杂性和挑战性，假体间骨折需要对骨折病因进行充分分析，并将其转化为最佳治疗概念。
