Review Question - QID 8342

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THA Periprosthetic Fracture QID: 8342 (SAE13HK.10)

QID 8342 (Type "8342" in App Search)

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?

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Open reduction and cerclage fixation of the fracture

14%

299/2081

Open reduction and revision of the femoral implant to a long cemented stem

12%

254/2081

Open reduction and revision of the femoral implant to a long fluted and tapered uncemented stem

72%

1497/2081

Application of balanced traction and surgery after the ecchymosis has resolved

9/2081

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This patient has a periprosthetic femoral fracture with a loose femoral stem and normal femoral bone stock (Vancouver type B2). The most appropriate treatment is fixation of the fracture along with revision of the stem. Considering his age, bone quality, and activity level, a longer uncemented stem is most predictable. Although a cylindrical stem may also be used, the fluted stem option is the only uncemented choice listed and the most appropriate response. A cemented stem is a poorer choice because it is difficult to keep the cement out of the fracture site; this would pose risk for nonunion at the fracture, and overall poorer results have been associated with long cemented stems in healthy, active people. Surgery does not need to be delayed to allow the ecchymosis to resolve, and simple open reduction and fixation does not address the loose stem.