THA Periprosthetic Fracture

(OBQ18.80) A 75-year-old male sustains a ground-level fall while ambulating at home. The patient has been optimized for surgical intervention. Both prosthetic components are deemed to be stable. How would you classify this fracture and what is the appropriate treatment plan?

(OBQ18.221) A 65-year-old woman with a history of right total hip arthroplasty presents with a fall. Her injury radiographs are depicted in Figure A. What are the fracture classification and most appropriate treatment?

(OBQ18.22) A 79-year-old patient underwent a right hip hemiarthroplasty after sustaining a femoral neck fracture 8 weeks ago. The patient fell down in the nursing home and noticed immediate pain and inability to bear weight. Figures A and B are the radiographs of the right femur. What is the best treatment approach?

(OBQ17.97) An 85-year-old woman sustains a ground level fall. Her THA was done 25 years ago. She was previously ambulatory but with a significant limp. With regard to the femur specifically, what is the Vancouver classification and preferred treatment option?

(SBQ13HK.67.1) A 78-year-old woman who has a history of an uncomplicated right total hip arthroplasty presents after a fall. Figure A is the radiograph obtained in the emergency department. What is the most appropriate treatment for the femoral component?

(SAE13HK.10) A healthy, active 72-year-old man tripped and fell, landing on his left hip 10 weeks after an uncomplicated left primary uncemented total hip replacement. A radiograph taken 6 weeks after surgery and before the fall is shown in Figure 10a. A radiograph taken after the fall is shown in Figure 10b. He was unable to bear weight and was brought to the emergency department. Examination revealed a slightly shortened left lower extremity and some mild ecchymosis just distal to the left greater trochanteric region, but his skin was intact without abrasions or lacerations. What is the most appropriate treatment?

(OBQ13.214) Which of the following fractures would most likely require revision arthroplasty with a long-stemmed, uncemented prosthesis?

(OBQ13.136) Figure A shows the image of a 72-year-old male who sustained a fall from standing. Past medical history is significant for hypertension. He was a community ambulator without the use of a cane or walker prior to the fall. During the operation, he is noted to have a well-fixed acetabular component without significant wear of his polyethylene liner, but his femoral component is easily extractable. Which of the following correctly pairs his Vancouver classification and appropriate surgical intervention?

(OBQ12.217) An 82-year-old male sustains a ground level fall and sustains the injury shown in Figure A. Which of the following treatment methods is most appropriate for treating this injury?

(OBQ12.78) A 78-year-old female undergoes total hip arthroplasty through a minimally invasive surgical approach. During insertion of a metaphyseal fixation stem with a cementless press-fit technique, a crack in the calcar is identified. The stem is removed, two cable wires are passed around the calcar, and the same stem is reinserted. Which of the following statements is true?

(SBQ11OS.20.1) A 91-year-old, minimally ambulatory male presents with acute on chronic progressive right thigh pain. Fifteen years ago, he underwent a right total hip replacement and he had been having progressive thigh start-up pain over the prior 5 months. He sustained a ground-level fall yesterday and he is now unable to bear any weight on the right leg. His current radiograph is shown in Figure A. His labs, including CBC, ESR, and CRP are all within normal limits. Which of the following represents the most appropriate next step in definitive management?

(SBQ10HK.77.1) A 73-year-old man who underwent a cementless total hip arthroplasty 8 years ago was in a high-speed motor vehicle accident and sustained the injury seen in Figure A. Appropriate management includes which of the following?

(OBQ10.108) A 67-year-old man 6 years status post right total hip arthroplasty falls while walking his dog. He complains of pain and is unable to bear weight through the right leg. He denies any hip or thigh pain prior to this fall. A radiograph is provided in figure A. Which of the following is the most appropriate management?

(OBQ10.26) In his first day home after undergoing a total hip arthroplasty a 65-year-old male falls down the stairs and sustains the fracture seen in Figure A and B. Intra-operative examination reveals the stem to be loose. What is the preferred treatment for this injury?

(OBQ09.140) A previously healthy 68-year-old woman falls and sustains the fracture seen in Figure A. Her index procedure was approximately 10 years ago. The patient is taken to surgery, and the femoral stem is found to be loose. The acetabular component is found to be well fixed in good position. In addition to using a new poly liner, what other procedure(s) is now indicated in this patient?

(OBQ08.125) A 65-year-old healthy patient fell 18 years after a total hip arthroplasty and sustained the fracture shown in Figure A. Which of the following would be the most appropriate treatment?

(OBQ08.268) A nondisplaced periprosthetic small posterior wall acetabular fracture is noted intra-operatively during total hip arthroplasty. The acetabular component is stable and well-fixed after implantation of an ingrowth acetabular shell during intraoperative examination. Which of the following treatment options will best maintain motion and clinical function?

(SAE07HK.28) Figure 16 shows the radiograph of an otherwise healthy 62-year-old woman who fell. Management should consist of

(SAE07HK.88) During impaction of a cementless acetabular component, the posterior column was fractured and found to be displaced. Which of the following is considered the most appropriate surgical option?

(SAE07HK.72) In the radiograph shown in Figure 42, the fracture pattern around this well-fixed stem is classified as Vancouver type

(SAE07HK.68) A 53-year-old patient is seen in the emergency department after sustaining a fall onto her left hip. A current radiograph is shown in Figure 40. What is the best treatment option?

(SAE07HK.62) Figure 37 reveals a periprosthetic fracture around a cemented femoral stem in an 81-year-old patient with Paget’s disease and mild coagulopathy. What is the most appropriate reconstructive management on the femoral side?

(SAE07HK.59) Figure 36 shows the radiograph of a patient who has hip pain and is unable to ambulate. What is the most appropriate management for this patient?

(SAE07HK.49) Figure 28 shows the postoperative radiograph of a 36-year-old patient. The cerclage cable was placed for a minimal medial calcar fracture seen during femoral preparation. In the immediate postoperative period, what is the highest level of activity that would be safely permitted?

(SAE07HK.16) Figure 10 shows the AP radiograph of an ambulatory 76-year-old patient. What is the most appropriate surgical treatment option for this patient?

(SBQ07HK.62) A 88-year-old female fell onto her right hip sustaining the fracture shown in Figure A. Past medical history is significant for mild dementia and moderate coronary artery disease. At baseline, she ambulates with a walker. There are concerns about her ability to maintain weight-bearing precautions following surgery. Which of the following is most appropriate for management of the femoral side?

(OBQ06.180) A 78-year-old male falls at home four months following a right total hip arthroplasty. Right leg deformity, pain, and inability to bear weight are present on physical exam. An injury radiograph is provided in Figure A, while radiographs taken immediately following the initial total hip arthroplasty are provided in Figures B and C. The patient denies any prodromal groin pain prior to his fall. Which of the following is the best treatment option?

(OBQ05.173) During insertion of a cementless femoral stem, a nondisplaced fracture is noticed along the femoral calcar. Which of the following is the most appropriate next step in surgical management?

(OBQ05.124) An 82-year-old woman falls and sustains the fracture shown in figure A. She denies any history of dislocation or prodromal pain prior to her fall. What is the most appropriate treatment?

(OBQ04.244) While performing a cementless total hip arthroplasty in a healthy 68-year-old female, the surgeon notes an audible change while impacting the final broach. The broach is removed and a 1cm longitudinal crack originating at the calcar is visualized. Bone stock is otherwise preserved. What is the next best step in management?

(OBQ04.232) A 67-year-old man who underwent total hip arthroplasty (THA) 4 years ago fell on to his right hip. His pre-injury right hip film is seen in Figure A while films of his current injury are seen in Figures B and C. Prior to the fall he had no thigh or hip pain. His ESR and CRP are within normal limits. During intraoperative assessment, the acetabular and femoral stems are found to be well fixed. What is the next best course of action?