2019 Volume 38 Issue 1 Pages 35-41
Periprosthetic fractures are technically demanding to treat, as they require the skills of revision arthroplasty as well as those of trauma surgery. The elderly population is particularly vulnerable to low energy periprosthetic fractures attributed to osteopenia or osteoporosis leaving limited reconstruction options to the hip revision surgeon.
We report a case of revision total hip arthroplasty (THA) with femoral bone deficiency. For preventing intraoperative periprosthetic femoral fracture, femoral impaction bone grafting (IBG) with locking compression plate (LCP) for revision THA was undertaken. However, it was necessary to perform a third surgery for postoperative Vancouver B1 periprosthetic femoral fracture, by treatment with LCP and auto-fibula fixation.
A 76-year-old woman underwent bipolar hip arthroplasty in our hospital for femoral neck fracture 14 years before presentation, and revision surgery for stem loosening. She underwent revision THA using femoral IBG with LCP four months later. The patient fell down when standing and a periprosthetic femoral shaft fracture (Vancouver classification type B1) was observed on the plain radiographs. She was treated with LCP fixation and autograft fibula fixation using ultra-high molecular weight polyethylene adding with morselized and cancellous allografts around the periprosthetic fracture. Two years after surgery, clinical and radiographic follow-up revealed that the fracture had healed without deformity or shortening.
She currently walks smoothly and without pain using a single walking stick.
