Indikationen, chirurgische Technik und Ergebnisse der Osteosynthese bei periprothetischen Frakturen am proximalen Femur

Aufgrund des demografischen Wandels und Zunahme der Implantationen von Hüfttotalendoprothesen steigt auch die Inzidenz periprothetischer Frakturen des Hüftgelenkes (Azetabulum, Femur). Etablierte Klassifikationen bilden die Grundlage für ein differenziertes Behandlungskonzept. Zur Vermeidung der hohen Zahl postoperativer Komplikationen ist die exakte Analyse der Frakturursachen unabdingbar und ein individuell auf den Patienten angepasstes Therapiekonzept notwendig. Ziel der Behandlung ist die Wiederherstellung der Funktion und Mobilität des Patienten auf das Niveau vor dem Sturz.

Abstract

Due to demographic changes and increasing rates of implantations of total hip arthroplasties the incidence of periprosthetic proximal femoral fractures is increasing as well. Current well-established classifications provide the base for distinguished treatment concepts. To prevent postoperative complications an accurate analysis of fracture causes has to be done as well as an individual patient-oriented treatment concept. The aim of the therapy is to restore and maintain the patient’s mobility and function to their pretrauma level.

Schlüsselwörter

periprothetische proximale Fraktur - Alterstraumatologie - Biomechanik - Revisionsendoprothetik - Komplikationsmanagement - Osteoporose - Osteosynthese

Keywords

periprosthetic proximal femur fracture - geriatric trauma - biomechanics - revision total hip arthroplasty - complication management - osteoporosis - osteosynthesis

Publication History

Article published online:
10 November 2025

• Literatur

• 1 Moreta J, Aguirre U, de Ugarte OS. et al. Functional and radiological outcome of periprosthetic femoral fractures after hip arthroplasty. Injury 2015; 46: 292-298
• 2 Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet 2007; 370: 1508-1519
• 3 Wengler A, Nimptsch U, Mansky T. Hüft- und Kniegelenkersatz in Deutschland und den USA. Dtsch Arztebl Int 2014; 111: 407-416
• 4 Minutillo GT, Karnuta JM, Koressel J. et al. Fixation or Revision for Periprosthetic Fractures: Epidemiology, New Trends, and Projections in the United States. J Bone Joint Surg Am 2024; 106: 1054-1061
• 5 Sloan M, Premkumar A, Sheth NP. Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018; 100: 1455-1460
• 6 Lamb JN, Evans JT, Relton S. et al. The incidence of postoperative periprosthetic femoral fracture following total hip replacement: An analysis of UK National Joint Registry and Hospital Episodes statistics data. PLoS Med 2024; 21: e1004462
• 7 Lamb JN, West RM, Relton SD. et al. The Risk of Postoperative Periprosthetic Femoral Fracture After Total Hip Arthroplasty Depends More on Stem Design Than Cement Use: An Analysis of National Health Data from England. J Bone Joint Surg Am 2025; 107: 476-487
• 8 Mondanelli N, Troiano E, Facchini A. et al. Treatment Algorithm of Periprosthetic Femoral Fracturens. Geriatr Orthop Surg Rehabil 2022; 13: 21514593221097608
• 9 Tahir MM, Khan DN, Chaudhry MEA. et al. RETRACTED: A Multicentre Randomized Controlled Trial Comparing Plating with Intramedullary Nailing for Extra-articular Distal Tibial Fractures. Injury 2020; 52: 19-25
• 10 Kurokawa H, Takegami Y, Tokutake K. et al. Predictive factors for one-year mortality after surgery for periprosthetic femoral fracture: A retrospective multicenter (TRON group) study. J Orthop Sci 2024; 29: 299-305
• 11 Bhattacharyya T, Chang D, Meigs JB. et al. Mortality after periprosthetic fracture of the femur. J Bone Joint Surg Am 2007; 89: 2658-2662
• 12 Moreta J, Uriarte I, Bidea I. et al. High mortality rate following periprosthetic femoral fractures after total hip arthroplasty. A multicenter retrospective study. Injury 2021; 52: 3022-3027
• 13 Young SW, Walker CG, Pitto RP. Functional outcome of femoral peri prosthetic fracture and revision hip arthroplasty: a matched-pair study from the New Zealand Registry. Acta Orthop 2008; 79: 483-488
• 14 Singh JA, Jensen MR, Harmsen SW. et al. Are gender, comorbidity, and obesity risk factors for postoperative periprosthetic fractures after primary total hip arthroplasty?. J Arthroplasty 2013; 28: 126-131.e1–2
• 15 Sidler-Maier CC, Waddell J. P. Incidence and predisposing factors of periprosthetic proximal femoral fractures: a literature review. Int Orthop 2015; 39: 1673-1682
• 16 Cai L, Zhu S, Du S. et al. The relationship between radiographic parameters and clinical outcome of distal radius fractures in elderly patients. Orthop Traumatol Surg Res 2015; 101: 827-831
• 17 Cook RE, Jenkins PJ, Walmsley PJ. et al. Risk factors for periprosthetic fractures of the hip: a survivorship analysis. Clin Orthop Relat Res 2008; 466: 1652-1656
• 18 Meek RM, Norwood T, Smith R. et al. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br 2011; 93: 96-101
• 19 Slullitel PA, Oñativia JI, Llano L. et al. Periprosthetic stress fracture around a well-fixed type 2B short uncemented stem. SICOT J 2018; 4: 33
• 20 Berry DJ. Periprosthetic fractures associated with osteolysis: a problem on the rise. J Arthroplasty 2003; 18(3 Suppl. 1): 107-111
• 21 Katz JN, Wright E, Harris MB. et al. Incidence, Risk Factors and Consequences of Periprosthetic and Femoral Fracture among Those Who Survived Total Hip Replacement for More Than a Decade. Osteoarthritis Cartilage 2012; 20: S163-S164
• 22 Frenzel S, Vécsei V, Negrin L. Periprosthetic femoral fractures—incidence, classification problems and the proposal of a modified classification scheme. Int Orthop 2015; 39: 1909-1920
• 23 Dorr LD, Faugere MC, Mackel AM. et al. Structural and cellular assessment of bone quality of proximal femur. Bone 1993; 14: 231-242
• 24 Busch A, Jäger M, Beck S. et al. Metal Artefact Reduction Sequences (MARS) in Magnetic Resonance Imaging (MRI) after Total Hip Arthroplasty (THA) : A non-invasive approach for preoperative differentiation between periprosthetic joint infection (PJI) and aseptic complications?. BMC Musculoskelet Disord 2022; 23: 620
• 25 Schopper C, Luger M, Hipmair G. et al. The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) – a systematic review. BMC Musculoskelet Disord 2022; 23: 280
• 26 Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect 1995; 44: 293-304
• 27 Duncan CP, Haddad FS. The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J 2014; 96-B: 713-716
• 28 Corten K, Vanrykel F, Bellemans J. et al. An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component. J Bone Joint Surg Br 2009; 91: 1424-1430
• 29 Hagel A, Siekmann H, Delank KS. Periprosthetic femoral fracture – an interdisciplinary challenge. Dtsch Arztebl Int 2014; 111: 658-664
• 30 Märdian S, Schaser KD, Duda GN. et al. Working length of locking plates determines interfragmentary movement in distal femur fractures under physiological loading. Clin Biomech (Bristol) 2015; 30: 391-396
• 31 Buttaro MA, Farfalli G, Paredes Núñez M. et al. Locking compression plate fixation of Vancouver type-B1 periprosthetic femoral fractures. J Bone Joint Surg Am 2007; 89: 1964-1969
• 32 Märdian S, Schaser KD, Gruner J. et al. Adequate surgical treatment of periprosthetic femoral fractures following hip arthroplasty does not correlate with functional outcome and quality of life. Int Orthop 2015; 39: 1701-1708
• 33 Märdian S, Rau D, Hinz P. et al. Acetabular Fractures in an Advanced Age – Current Knowledge and Treatment Options. Acta Chir Orthop Traumatol Cech 2017; 84: 241-246
• 34 Heyland M, Duda GN, Haas NP. et al. Semi-rigid screws provide an auxiliary option to plate working length to control interfragmentary movement in locking plate fixation at the distal femur. Injury 2015; 46 (Suppl. 4) S24-S32
• 35 Gwinner C, Märdian S, Dröge T. et al. Bicortical screw fixation provides superior biomechanical stability but devastating failure modes in periprosthetic femur fracture care using locking plates. Int Orthop 2015; 39: 1749-1755
• 36 Alexander J, Morris RP, Kaimrajh D. et al. Biomechanical evaluation of periprosthetic refractures following distal femur locking plate fixation. Injury 2015; 46: 2368-2373
• 37 Lenz M, Perren SM, Gueorguiev B. et al. A biomechanical study on proximal plate fixation techniques in periprosthetic femur fractures. Injury 2014; 45 (Suppl. 1) S71-S75
• 38 Link BC, Apivatthakakul T, Hill BW. et al. Minimally Invasive Plate Osteosynthesis (MIPO) of Periprosthetic Femoral Fractures with Percutaneous Cerclage Wiring for Fracture Reduction: Tips and Technique. JBJS Essent Surg Tech 2014; 4: e13
• 39 Choi JK, Gardner TR, Yoon E. et al. The effect of fixation technique on the stiffness of comminuted Vancouver B1 periprosthetic femur fractures. J Arthroplasty 2010; 25(6 Suppl.): 124-128
• 40 Lenz M, Stoffel K, Gueorguiev B. et al. Enhancing fixation strength in periprosthetic femur fractures by orthogonal plating-A biomechanical study. J Orthop Res 2016; 34: 591-596
• 41 Wähnert D, Grüneweller N, Gehweiler D. et al. Double plating in Vancouver type B1 periprosthetic proximal femur fractures: A biomechanical study. J Orthop Res 2017; 35: 234-239
• 42 Kubik JF, Bornes TD, Gausden EB. et al. Surgical outcomes of dual-plate fixation for periprosthetic femur fractures around a stable hip arthroplasty stem. Arch Orthop Trauma Surg 2022; 142: 3605-3611
• 43 Ruchholtz S, El-Zayat B, Kreslo D. et al. Less invasive polyaxial locking plate fixation in periprosthetic and peri-implant fractures of the femur--a prospective study of 41 patients. Injury 2013; 44: 239-248
• 44 Tsiridis E, Pavlou G, Venkatesh R. et al. Periprosthetic Femoral Fractures around Hip Arthroplasty: Current Concepts in their Management. Hip Int 2009; 19: 75-86
• 45 Lindahl H, Malchau H, Herberts P. et al. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 2005; 20: 857-865
• 46 Kammerlander C, Pfeufer D, Lisotano LA. et al. Inability of Older Adult Patients with Hip Fracture to Maintain Postoperative Weight-Bearing Restrictions. J Bone Joint Surg Am 2018; 100: 936-941
• 47 Kammerlander C, Pfeufer D, Lisitano LA. et al. Inability of Older Adult Patients with Hip Fracture to Maintain Postoperative Weight-Bearing Restrictions. J Bone Joint Surg Am 2018; 100: 936-941