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Revision to a proximal femoral replacement
73%
1896/2599
Open reduction and internal fixation with proximal femoral locking plate and cerclage cables
4%
92/2599
Revision to a cemented long femoral stem
7%
186/2599
Open reduction and internal fixation with iliac crest bone grafting
1%
16/2599
Revision to a cementless long porous-coated femoral stem
15%
387/2599
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The patient has a Vancouver B3 periprosthetic femur fracture and requires revision. Given the extensive amount of bone loss in the proximal segment as well as a loose stem, a proximal femoral replacement would be an appropriate treatment Post-operative periprosthetic femur fractures are classified based on the Vancouver classification which classifies fractures based on the location of the fracture, implant stability, and bone loss. Vancouver B3 periprosthetic femur fractures are defined as fractures at, around, or just below the stem with significant proximal bone loss/osteopenia or comminution which is unable to allow for reconstruction. In the setting of these injuries, treatment would consist of endoprosthetic proximal femur replacement or replacement with a large proximal femur allograft. Della Valle et al. discuss the challenges associated with pre-operative planning for femoral revision total hip arthroplasty. The authors provide a classification of femoral bone loss that guides the surgeon in selecting an appropriate method of reconstruction. They conclude that appropriate pre-operative planning is required for the management of femoral implant revision in the setting of fracture, osteolysis, and instability. Brown et al. reviewed the indications for revision THA to include instability, aseptic loosening, osteolysis, infection, periprosthetic fracture, component malposition, and catastrophic implant failure. They note that femoral component revision presents a complex challenge to the arthroplasty surgeon because of modern implant design as well as bone loss in the proximal femur. They conclude that knowledge of various reconstructive options and the indications for each is necessary to achieve a successful outcome. Figure A is the radiograph of a periprosthetic femur fracture with extensive proximal femoral bone loss consistent with a Vancouver B3 periprosthetic femur fracture. Illustrations A and B are the radiographs revealing a revision total hip arthroplasty with proximal femur endoprosthetic reconstruction. Incorrect Answers: Answer 2, 3, 4 and 5: The patient has sustained a periprosthetic femur fracture and extensive osteopenia with bone loss and a loose stem. He requires revision with a proximal femoral replacement or a proximal femoral allograft
3.3
(3)
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