PERIPROSTHETIC AND PERI-IMPLANT FRACTURES ORTHOPAEDICS

1. PeriProsthetic and
peri-implant
Fractures
Dr.ADARSH RS
MS ORTHO RESIDENT
MES MEDICAL COLLEGE

2.  Fractures that are associated with the Joint prosthesis or implant
 They occur due to :
 1. Trauma
 2. Osteolysis
 3. Osteoprosis It occur mostly in old age with osteoporosis
 Increasing cases now a days
 Increase in primary and revision arthroplasty
 Increasing life expectancy
 Increase in RTA

3. Epidemiology
 postoperative PF after primary total hip arthroplasty
(THA) ranging from 0.1 to 18%,
 after total knee arthroplasty (TKA) from 0.3 and 5.5%
 after total shoulder arthroplasty (TSA) from 0.5 to 3%
 Intra op 1.7% for THA, 3% in TKA,1.2 % in TSA
 75% are due to low energy Trauma More commonly seen in
• Females • Young patient

4. Mechanism of injury
 Low energy falls account for mechanism of injury in
most patient with lower limb ppf
 • Lower limb fractures occur most commonly Post-
operatively where as upper limb fracture most
commonly occur in Intra Operatively •
 75% of all prei-prosthetic femur fracture occur post
operatively with low energy trauma •
 Peri-prosthetic fracture most commonly post revision
surgery then primary surgery because of reduced bone
stock

5. Risk Factors
 1. Patient Related :
 • Age of patient (younger > older)
 • Gender (female > male)
 • Presence or absence of osteolysis •
 Type of prosthesis used (uncemented > Cemented) •
 Coexisting medical co-morbidties
 • Osteoporosis
 • Rheumatoid Arthrities

6.  Surgeon Related :
 • Inadequate exposure
 • Underreaming
 • Over Reaming
 • Heavy impaction
 • Malpositioning of prosthesis

7. Sign and Symptoms
 History of trauma
 • Start up of abrupt pain
 • Increase difficulty with ambulation
 • Progressive limb shortening
 • Increasing deformity of the extremity
 all this lead to implant loosening

8. Investigation
 X ray
 CT
 MRI

9. GOALS of treatment
 • Timely and uncomplicated fracture union
 • Restoration of alignment
 • Return of pre injury level of pain and function
 • Stability of prosthesis
 • Restoration of adequate bone stock to maximize
potential success

17. Felix classification

22. Peri prosthetic fracture
About shoulder arthroplasty

26. Non-prosthetic peri-implant
fractures

28. Modified paprosky
classification