Taniguchi Hiroto, Yoshimoto Nobuyuki, Okazaki Ken
Department of Orthopaedic Surgery, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan.
Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.
J Orthop Case Rep. 2023 Aug;13(8):63-68. doi: 10.13107/jocr.2023.v13.i08.3818.
In an aging society, the incidence of periprosthetic fractures will increase owing to the increasing number of patients undergoing joint replacement surgery. We experienced a case of recurrent periprosthetic fracture in a patient who had undergone ipsilateral hip bipolar hemiarthroplasty (BHA) and total knee arthroplasty. Based on our experience, we discuss the treatment strategy for periprosthetic fractures in patients at a high risk of fall.
An 84-year-old woman, who had undergone total knee arthroplasty 9 years ago and ipsilateral hip BHA 2 years ago, sustained a knee condylar fracture (Su classification type III) due to fall. This knee periprosthetic fracture posed a challenge for osteosynthesis; therefore, revision total knee arthroplasty was performed using a hinge-type prosthesis. During this surgery, we installed a reinforcement plate on the femoral shaft to prevent fractures because of the short stem tip distance between the hip and knee prosthesis (53 mm). The procedure was successful, and the patient regained her walking ability. However, 6 months after surgery, the patient sustained a hip periprosthetic fracture (Vancouver type B2) due to a fall, despite precautionary plate installation. In case of hip stem insertion, the stress caused by fall is concentrated on the infratrochanteric region, as reflected in her fracture site. From a mechanical perspective, this fracture was not accidental. The plate reinforcement procedure may have been inadequate because the top of the plate was located at the infratrochanteric region.
Periprosthetic fractures may occur despite the installation of a plate for fracture prevention. With a total hip arthroplasty or hip BHA stem inserted, a fall could result in a subtrochanteric fracture.
在老龄化社会中，由于接受关节置换手术的患者数量不断增加，假体周围骨折的发生率将会上升。我们遇到了一例在同侧髋关节双极半关节成形术（BHA）和全膝关节置换术后发生复发性假体周围骨折的患者。基于我们的经验，我们讨论了对有高跌倒风险患者的假体周围骨折的治疗策略。
一名84岁女性，9年前接受了全膝关节置换术，2年前接受了同侧髋关节BHA，因跌倒导致膝关节髁间骨折（苏分类III型）。这种膝关节假体周围骨折给骨固定带来了挑战；因此，使用铰链式假体进行了全膝关节置换翻修手术。在这次手术中，我们在股骨干上安装了一块加强板，以防止因髋部和膝部假体之间的柄尖距离短（53毫米）而导致骨折。手术成功，患者恢复了行走能力。然而，术后6个月，尽管安装了预防性钢板，患者仍因跌倒导致髋部假体周围骨折（温哥华B2型）。在进行髋部柄插入时，跌倒引起的应力集中在转子下区域，这在她的骨折部位得到了体现。从力学角度来看，这次骨折并非偶然。由于钢板顶部位于转子下区域，钢板加固手术可能并不充分。
尽管安装了预防骨折的钢板，假体周围骨折仍可能发生。在插入全髋关节置换或髋关节BHA柄的情况下，跌倒可能导致转子下骨折。
