This document provides an outline and introduction for a presentation on the management of periprosthetic fractures. It discusses definition, epidemiology, risk factors, classifications, treatment goals and options, and complications for periprosthetic fractures of the hip, knee, and shoulder. Key points covered include the Vancouver classification system for femoral fractures, surgical treatment approaches depending on the fracture type, and challenges in treating acetabular fractures.
a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
muscle pedicle grafting for delayed presentation of intra cpasular fracture neck of Femur.. a study of 65 cases in Osmania Medical College, Hyderabad, Telengana.
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
muscle pedicle grafting for delayed presentation of intra cpasular fracture neck of Femur.. a study of 65 cases in Osmania Medical College, Hyderabad, Telengana.
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Background: The third most common musculoskeletal symptom in orthopaedic clinical practice is a sore shoulder, which can cause significant morbidity. It has been reported that 7–27% of the general population has it, and 36–66% of overhead arm athletes have it. Pathophysiology includes functional, degenerative, and mechanical factors. Most shoulder pain is subacromial pain syndrome (SAPS), often known as ‘shoulder impingement syndrome’. Impingement hypothesis: shoulder joint structures mechanically clash. SAPS accounts for 36–48% of shoulder discomfort. Methods: This observational study was conducted in the Department of Orthopaedics, MKCG Medical College and Hospital, Berhampur, among Eastern Indian outpatients. The study included adult patients (ages 18–75) of both sexes who presented to MKCG Medical College and Hospital's OPD with shoulder pain from December 2020 to November 2022 and were diagnosed with Shoulder Impingement Syndrome (SIS). Thorough histories and clinical exams were done. The Department of Radiology, MKCG Medical College and Hospital, Berhampur, performed conventional shoulder MRIs on the selected participants. Results: Most cases and controls were Type-II (43.3%), followed by Type-I (28.3% and 30%, 29.2% of the total group). The study's least common acromial shape was type-IV, seen in 5% of cases and 10% of controls (7.5% of the sample). Fisher's exact test showed no significant connection between subacromial impingement and acromial shape (p=0.65). With a p-value of 0.045, cases had a significantly greater acromial width (8.12±2.16 mm) than controls (7.51±0.81 mm). Conclusion: Sub-acromial impingement was unrelated to acromion morphology. There was no correlation between acromial morphology and rotator cuff injuries.
Key-words: Shoulder Impingement Syndrome, Acromion Morphology, MRI
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3. Introduction
Periprosthetic fractures
#s that occur in association with Joint prosthesis
They occur due to
Trauma
Osteolysis
Osteoporosis
Treatment is complex
Prosthesis may be loose
Bone cement may impede reduction
WACS Intensive Revision Course in Orthopaedics & Trauma
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Expertise for optimal care:
• Fracture fixation &
• Joint reconstruction
4. Introduction…
Arthroplasty
An extremely effective procedure in relieving pain & joint dysfunction
Now frequently performed worldwide
WACS Intensive Revision Course in Orthopaedics & Trauma
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Periprosthetic #s
are now a standard problem that the
Arthroplasty surgeon has to deal
with fairly commonly either
intraoperative or later
5. Introduction…
Prevention is better than cure
....but when # occurs
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Best outcome is achieved
when the surgeon has
good understanding of the
principles of treatment &
access to various fixation
and reconstruction devices
6. Epidemiology
The largest series of periprosthetic fracture (THA)
1% after primary and 4% after revision THA
75% are due to low energy trauma
For TKA:
0.3% to 5.5% for primary TKA and up to 30% for revision
Supracondylar femur fractures are the most common
For Shoulder Arthroplasty:
0.5 – 3%
For both hemi & TSA
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7. Risk Factors
Patients related
Rh arthritis
Chronic steroid use
Neurological disorders
Osteoporosis
Female gender
Advanced age
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12. Classifications (Femur)
Several classification systems:
American Academy of Orthopedic Surgeons (AAOS)
Cooke & Newman (modified Bethea)
Johansson classification
Vancouver
Most widely used, based on:
Location of # relative to prosthesis
Stability of prosthesis
Quality of the surrounding bone
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13. Vancouver Classification
A: # involve the trochanteric area
A(G): greater trochanter
A(L): lesser trochanter
B: around the stem or just below it
B1: stem stable
B2: stem loose
B3: stem loose, bone stock inadequate
C: well below the stem
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14. Treatment
Goals:
Prosthesis stability
Fracture union
Preserve hip function
Principles
Stable fixation
Extensile incision
Minimize soft tissue damage
Revision of loose components
Accurate fracture reduction
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22. Acetabular #
Rare: 0.07 % (Peterson et al 1996)
Disastrous complication of THA
Usually intraoperative
Seen with Cementless THR
Rare in Cemented THR
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23. Classification (Acetabular #)
Many classifications have been proposed:
Peterson and Lewallen
AAOS
Unified classification system (UCS)
Della Valle
Comprehensive
Reproducible
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24. Treatment
Goals:
Rigid fixation for bony union
Stable integration of component
Re-establishing:
CoR
Offset
Limb length
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32. Treatment (Acetabular #)
Pelvic discontinuity due to osteolysis
Small defect / Good bone quality
Contained ant. & post. Acetabular rim
ORIF with posterior column plate
+ Bone grafting
+ Revision cup
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33. Treatment (Acetabular #)
Pelvic discontinuity due to osteolysis
Large defect / Good bone quality
Bicolumnar plating + BG
+ Highly porous tantalum shell
Alternatively: Protrusion ring + BG
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35. Treatment (Acetabular #)
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Pelvic discontinuity due to osteolysis
Large defect / Poor defect
A cup-cage construct augment
Reconstruction ring
+ Highly porous cup
+ Cemented Polyethylene cup
Can be single or 2-Staged
38. Periprosthetic Fractures (TKR)
Can occur in the femur, tibia or patella
Within 15 cm from the joint surface
Or within 5 cm from the intramedullary stem
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Elderly:
Combined medical
conditions often disrupt
postoperative recovery
and rehabilitation.
39. Classifications
Neer Classification
I – undisplaced.
II – displaced >1 cm.
IIa – medial shaft displaced.
IIb – lateral shaft displaced.
III – comminuted.
IV – diaphyseal # above TKR
V – periprosthetic # of the tibia
Limitation
Stabilty of prosthesis ?
Bone quality ?
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40. Classifications…
Rorabeck & Taylor (1998)
I - Non-displaced #
Stable prosthesis
II - ≥5 mm displacement
Stable prosthesis
IIA (non-comminuted)
IIB (comminuted)
III - fracture is accompanied by
component loosening
Limitations
Tibia ?
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46. Periprosthetic Fractures (Shoulder)
(TSA/rTSA/hSA)
Intraoperative
Frequent during revision
Postoperative
High nonunion rate
WACS Intensive Revision Course in Orthopaedics & Trauma
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47. Classification
Wright and Cofield (1995)
Worland et al (1999)
Groh (2008)
Campbell et al
Duncan (UCS)
Kirchhoff et al (2016)
Most comprehensive to date
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Kirchhoff takes into account:
Type of humeral prosthesis
Status of the rotator cuff
Location of fracture
Fracture pattern
Implant stability
48. Classification…
Worland et al
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49. Treatment Algorism (Kirchhoff et al )
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56. West African Perspectives
TBS
Ignorance
Poverty
Technical supports
Health insurance
Infrastructure
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57. Take Home Message
Periprosthetic #s are now not uncommon
Severe complication in joint reconstruction
Management is mainly surgical & can be challenging
Prevention is better
Proper assessment of # & prosthetic stability are crucial
WACS Intensive Revision Course in Orthopaedics & Trauma
(September 2019) doctoraroju@yahoo.com
Nonoperative therapy is only justified in
nondisplaced #s with stable prosthesis
and prolonged monitoring is mandatory
59. References
Aaron G, Adam G, Timothy S, Michael K. Periprosthetic humerus fractures: classification, management, and review
of the literature. Ann Joint 2018; 3:49
Harry R, Jonathan M. Femoral shaft, distal femoral and periprosthetic fractures. In: Sebastian DB, Pramod A,
Timothy B, Manoj R. Orthopaedic Trauma; The Stanmore and Royal London Guide. CRC Press Taylor & Francis
Group 2015; 18: 247 – 257
Jae DY, Nam KK. Periprosthetic Fractures Following Total Knee Arthroplasty. Knee Surg Relat Res 2015;27(1):1-9
Bassam AM, Dominic RM, Clive PD. Periprosthetic fracture evaluation & treatment. Clin Ortho 2004; 420: 80 – 95
Gregory JD, Kwok SL, Hans-Christoph P. Periprosthetic Fractures: Epidemiology and Future Projections. J Orthop
Trauma 2011; 25: S66–S70
Greiner S, Stein V, Scheibel M. Periprosthetic Humeral Fractures after Shoulder and Elbow Arthroplasty. Acta
Chirurgiae Orthopaedicae Et Traumatologiae Čechosl. 2011; 78: 490–500
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