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Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip ReplacementFunding None.
Objective The aim of this study was to report outcomes in dogs with periprosthetic femoral fractures associated with a press-fit cementless femoral total hip replacement implant.
Materials and Methods Electronic medical records and digital radiographs were used to identify dogs with periprosthetic femoral fractures associated with press-fit cementless total hip replacement. Data collected included signalment, weight, time of fracture, cause of fracture, presence of intra-operative fissure, fracture type, repair technique, and clinical and radiographic outcomes. Long-term patient outcome was assessed by communication with owners or referring veterinarians.
Results Twenty-eight dogs with femoral fracture repair associated with cementless press-fit total hip replacement were identified. Eight of the fractures occurred intraoperatively and 20 occurred at a median of 2 days postoperatively. An oblique or spiral configuration was noted in 19 cases and 15 occurred at the distal end of the femoral stem (type B), with thirteen type B1, one type B2 and one type B3 fractures. Fractures were repaired with non-locking (18/28) or locking-plate fixation (10/28). Cerclage wire was applied around the plate and proximal bone segment in 17/28 dogs. Major complications occurred in 7/28 cases (five deep infection, two mechanical failures). Bone healing was noted in 21/23 cases, for which follow-up radiographic interpretation was available. Return to function was complete in 17 cases, acceptable in 8 cases and unacceptable in 3 cases.
Conclusions While cementless total hip replacement periprosthetic femoral fractures can be successfully repaired with lateral plate fixation, the risk of infection appears to be high.
Keywordscerclage wire - fracture healing - implant infection - arthroplasty - periprosthetic femoral fracture
Isobel C. Monotti and Christopher A. Preston contributed to conception of study, study design, acquisition of data and data analysis and interpretation. Scott W. Kidd contributed to acquisition of data and data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.
Conflict of Interest
Received: 29 May 2019
Accepted: 24 February 2020
30 April 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Stuttgart · New York
- 1 Kidd SW, Preston CA, Moore GE. Complications of porous-coated press-fit cementless total hip replacement in dogs. Vet Comp Orthop Traumatol 2016; 29 (05) 402-408
- 2 Liska WD. Femur fractures associated with canine total hip replacement. Vet Surg 2004; 33 (02) 164-172
- 3 Ganz SM, Jackson J, VanEnkevort B, Vanenkevort B. Risk factors for femoral fracture after canine press-fit cementless total hip arthroplasty. Vet Surg 2010; 39 (06) 688-695
- 4 Fitzpatrick N, Nikolaou C, Yeadon R, Hamilton M. String-of-pearls locking plate and cerclage wire stabilization of periprosthetic femoral fractures after total hip replacement in six dogs. Vet Surg 2012; 41 (01) 180-188
- 5 Henderson ER, Wills A, Torrington AM. , et al. Evaluation of variables influencing success and complication rates in canine total hip replacement: results from the British Veterinary Orthopaedic Association Canine Hip Registry (collation of data: 2010-2012). Vet Rec 2017; 181 (01) 18-23
- 6 Townsend S, Kim SE, Pozzi A. Effect of stem sizing and position on short-term complications with canine press fit cementless total hip arthroplasty. Vet Surg 2017; 46 (06) 803-811
- 7 Masri BA, Meek RM, Duncan CP. Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 2004; (420) 80-95
- 8 Pavone V, de Cristo C, Di Stefano A, Costarella L, Testa G, Sessa G. Periprosthetic femoral fractures after total hip arthroplasty: an algorithm of treatment. Injury 2019; 50 (Suppl. 02) S45-S51
- 9 Lamb JN, Baetz J, Messer-Hannemann P. , et al. A calcar collar is protective against early periprosthetic femoral fracture around cementless femoral components in primary total hip arthroplasty: a registry study with biomechanical validation. Bone Joint J 2019; 101-B (07) 779-786
- 10 Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect 1995; 44: 293-304
- 11 Lee S, Kagan R, Wang L, Doung YC. Reliability and validity of the Vancouver classification in periprosthetic fractures around cementless femoral stems. J Arthroplasty 2019; 34 7S S277-S281
- 12 Wang K, Kenanidis E, Miodownik M, Tsiridis E, Moazen M. Periprosthetic fracture fixation of the femur following total hip arthroplasty: a review of biomechanical testing - Part II. Clin Biomech (Bristol, Avon) 2019; 61 (61) 144-162
- 13 Dennis MG, Simon JA, Kummer FJ, Koval KJ, DiCesare PE. Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques. J Arthroplasty 2000; 15 (04) 523-528
- 14 Schmotzer H, Tchejeyan GH, Dall DM. Surgical management of intra- and postoperative fractures of the femur about the tip of the stem in total hip arthroplasty. J Arthroplasty 1996; 11 (06) 709-717
- 15 Schwarzkopf R, Oni JK, Marwin SE. Total hip arthroplasty periprosthetic femoral fractures: a review of classification and current treatment. Bull Hosp Jt Dis (2013) 2013; 71 (01) 68-78
- 16 Berend KR, Lombardi Jr AV, Mallory TH, Chonko DJ, Dodds KL, Adams JB. Cerclage wires or cables for the management of intraoperative fracture associated with a cementless, tapered femoral prosthesis: results at 2 to 16 years. J Arthroplasty 2004; 19 (07) (Suppl. 02) 17-21
- 17 Carvajal JL, Kim SE, Pozzi A. Use of a cerclage cable-plate system to stabilize a periprosthetic femoral fracture after total hip replacement in a dog. Vet Surg 2019; 48 (03) 437-443
- 18 Cook JL, Evans R, Conzemius MG. , et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010; 39 (08) 905-908
- 19 Johnson KA. Piermattei's Atlas of Surgical Approaches to the Bones and Joint of the Dog and Cat. 5th ed. Missouri: Elsevier Inc; 2014
- 20 Korani HM, Marcellin-Little DJ, Roe SC. Variability associated with assessing changes in position of a canine uncemented femoral stem prosthesis. Vet Comp Orthop Traumatol 2015; 28 (06) 409-416
- 21 Liska WD, Doyle ND. Use of an electron beam melting manufactured titanium collared cementless femoral stem to resist subsidence after canine total hip replacement. Vet Surg 2015; 44 (07) 883-894
- 22 Davenport D, Hutt JR, Mitchell PA, Trompeter A, Kendoff D, Sandiford NA. Management of peri-prosthetic fractures around total hip arthroplasty: a contemporary review of surgical options. Ann Joint 2018; 3 (09) 65-65
- 23 Ozan F, Koyuncu S, Pekedis M, Altay T, Yıldız H, Toker G. Greater trochanteric fixation using a cable system for partial hip arthroplasty: a clinical and finite element analysis. BioMed Res Int 2014; 2014: 931537
- 24 Marcellin-Little DJ. Femoral fissures and fractures. Presented at: Proceedings: Total Joint Conference; Chicago, IL; May 18–19, 2018; Biomedtrix:12
- 25 Pernell RT, Milton JL, Gross RS. , et al. The effects of implant orientation, canal fill, and implant fit on femoral strain patterns and implant stability during catastrophic testing of a canine cementless femoral prosthesis. Vet Surg 1995; 24 (04) 337-346
- 26 Jasty M, Bragdon CR, Rubash H, Schutzer SF, Haire T, Harris W. Unrecognized femoral fractures during cementless total hip arthroplasty in the dog and their effect on bone ingrowth. J Arthroplasty 1992; 7 (04) 501-508
- 27 McCulloch RS, Roe SC, Marcellin-Little DJ, Mente PL. Resistance to subsidence of an uncemented femoral stem after cerclage wiring of a fissure. Vet Surg 2012; 41 (01) 163-167
- 28 Schutzer SF, Grady-Benson J, Jasty M, O'Connor DO, Bragdon C, Harris WH. Influence of intraoperative femoral fractures and cerclage wiring on bone ingrowth into canine porous-coated femoral components. J Arthroplasty 1995; 10 (06) 823-829
- 29 Lindahl H, Malchau H, Odén A, Garellick G. Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br 2006; 88 (01) 26-30
- 30 Bergh MS, Gilley RS, Shofer FS, Kapatkin AS. Complications and radiographic findings following cemented total hip replacement: a retrospective evaluation of 97 dogs. Vet Comp Orthop Traumatol 2006; 19 (03) 172-179
- 31 Voigt J, Mosier M, Darouiche R. Antibiotics and antiseptics for preventing infection in people receiving revision total hip and knee prostheses: a systematic review of randomized controlled trials. BMC Infect Dis 2016; 16 (01) 749
- 32 Hummel DW, Lanz OI, Werre SR. Complications of cementless total hip replacement. A retrospective study of 163 cases. Vet Comp Orthop Traumatol 2010; 23 (06) 424-432
- 33 Forster KE, Wills A, Torrington AM. , et al. Complications and owner assessment of canine total hip replacement: a multicenter internet based survey. Vet Surg 2012; 41 (05) 545-550
- 34 Marcellin-Little DJ, DeYoung BA, Doyens DH, DeYoung DJ. Canine uncemented porous-coated anatomic total hip arthroplasty: results of a long-term prospective evaluation of 50 consecutive cases. Vet Surg 1999; 28 (01) 10-20
- 35 Cooper HJ, Roc GC, Bas MA. , et al. Closed incision negative pressure therapy decreases complications after periprosthetic fracture surgery around the hip and knee. Injury 2018; 49 (02) 386-391
- 36 Prins J, Donders JCE, Helfet DL. , et al. Periprosthetic femoral nonunions treated with internal fixation and bone grafting. Injury 2018; 49 (12) 2295-2301