Mid-term effectiveness of cerclage wires fixation in treatment of periprosthetic femoral fractures associated with primary hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENG Qi ,  ZHAO Fengchao , GUO Kaijin , ZHA Guochun , ZHENG Xin , PANG Yong

Department of Orthopaedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221006, P.R.China;

Corresponding author：

ZHAO Fengchao, Email: zhjianzh@sina.com

Keywords：

Hip arthroplasty; femur; periprosthetic fracture; cerclage wire

DOI：

10.7507/1002-1892.201704133

Video：

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Objective To evaluate the mid-term effectiveness of cerclage wires fixation in treating Mallory typeⅡperiprosthetic femoral fractures associated with primary hip arthroplasty. Methods A retrospective analysis was made in the data of 14 patients (14 hips) with Mallory typeⅡ periprosthetic femoral fractures associated with primary hip arthroplasty and treated with cerclage wires fixation between January 2010 and June 2011 (fracture group). Twenty-eight patients (28 hips) without periprosthetic femoral fractures associated with primary hip arthroplasty at the same stage were chosen as control group. The uncemented femoral prosthesis were used in 2 groups. There was no significant difference in gender, age, body mass index, and primary disease between 2 groups (P>0.05). The operation time, intraoperative blood loss, and the complications were recorded. The Harris score was used to evaluate the hip function and the visual analogue scale (VAS) score was used to evaluate the pain degree of hip. According to the postoperative X-ray films of hips, Enghet al. standard was used to evaluate the fixed and stable status of the femoral prosthesis; the heterotopic ossification was observed; the time of fracture union was recorded. Results The operation time of fracture group was significantly longer than that of control group (t=–3.590, P=0.001). There was no significant difference in the intraoperative blood loss between 2 groups (t=–1.276, P=0.209). All patients were followed up 64-75 months (mean, 69.5 months). Hip dislocation after operation occurred in 1 case of fracture group; delirium symptom and nonunion of incision occurred in 1 case and 1 case of control group, respectively. There was no significant difference in the Harris score and VAS score at 6 months and 5 years between 2 groups (P>0.05). X-ray films showed that all fractures healed and the mean time of fracture union were 6.1 months (range, 3-12 months). There was no fracture nonunion or malunion evidently. There was no significant difference in X-ray score at 6 months and 5 years between 2 groups (P>0.05). At last follow-up, cerclage wires displacement or breakage did not occur. Heterotopic ossification occurred in 2 cases of fracture group and in 1 case of control group. Conclusion Cerclage wires fixation can achieve the good mid-term effectiveness in treating Mallory typeⅡintraoprative periprosthetic femoral fractures associated with primary hip arthroplasty.

Citation： CHENG Qi, ZHAO Fengchao, GUO Kaijin, ZHA Guochun, ZHENG Xin, PANG Yong. Mid-term effectiveness of cerclage wires fixation in treatment of periprosthetic femoral fractures associated with primary hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1291-1294. doi: 10.7507/1002-1892.201704133 Copy

1.	Pivec R, Issa K, Kapadia BH, et al. Incidence and Future Projections of Periprosthetic Femoral Fracture Following Primary Total Hip Arthroplasty: An Analysis of International Registry Data. J Long Term Eff Med Implants, 2015, 25(4): 269-275.
2.	Fleischman AN, Chen AF. Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls. Ann Transl Med, 2015, 3(16): 234.
3.	Ochsner PE, Hinchliffe R. Total Hip Replacement//Implantation Techniques and Local Complications. Berlin: Springer, 2003: 111-113.
4.	贾金鹏, 周勇刚, 王岩, 等. 首次全髋关节置换术中股骨假体周围骨折的原因分析与治疗.中国矫形外科杂志, 2005, 13(18): 1376-1378.
5.	Mallory TH, Kraus TJ, Vaughn BK. Intraoperative femoral fractures associated with cementless total hip arthroplasty. Orthopedics, 1989, 12(2): 231-239.
6.	Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res, 1990, (257): 107-128.
7.	Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury, 2007, 38(6): 651-654.
8.	Miettinen SSA, Mäkinen TJ, Kostensalo I, et al. Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty. Acta Orthopaedica, 2016, 87(2): 1-7.
9.	Masri BA, Meek RM, Duncan CP. Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res, 2004, (420): 80-95.
10.	Miettinen SS, Mäkinen TJ, Kostensalo I, et al. Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty. Acta Orthopaedica, 2016, 87(2): 1.
11.	Tsiridis E, Pavlou G, Venkatesh R, et al. Periprosthetic femoral fractures around hip arthroplasty: current concepts in their management. Hip Int, 2009, 19(2): 75-86.
12.	王建云, 姜世平, 何健飞, 等. 形状记忆合金环抱器或钛捆绑带治疗髋关节置换术后股骨假体周围骨折. 中国骨与关节损伤杂志, 2007, 22(5): 400-401.
13.	Munro JT, Garbuz DS, Masri BA, et al. Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures. Clin Orthop Relat Res, 2014, 472(2): 590-598.
14.	García-Rey E, García-Cimbrelo E, Cruz-Pardos A, et al. Increase of Cortical Bone After a Cementless Long Stem in Periprosthetic Fractures. Clin Orthop Relat Res, 2013, 471(12): 3912-3921.
15.	Zhang Z, Zhuo Q, Chai W, et al. Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty. Medicine (Baltimore), 2016, 95(35): e4751.
16.	Fleischman AN, Chen AF. Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls. Ann Transl Med, 2015, 3(16): 234.

1. Pivec R, Issa K, Kapadia BH, et al. Incidence and Future Projections of Periprosthetic Femoral Fracture Following Primary Total Hip Arthroplasty: An Analysis of International Registry Data. J Long Term Eff Med Implants, 2015, 25(4): 269-275.
2. Fleischman AN, Chen AF. Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls. Ann Transl Med, 2015, 3(16): 234.
3. Ochsner PE, Hinchliffe R. Total Hip Replacement//Implantation Techniques and Local Complications. Berlin: Springer, 2003: 111-113.
4. 贾金鹏, 周勇刚, 王岩, 等. 首次全髋关节置换术中股骨假体周围骨折的原因分析与治疗.中国矫形外科杂志, 2005, 13(18): 1376-1378.
5. Mallory TH, Kraus TJ, Vaughn BK. Intraoperative femoral fractures associated with cementless total hip arthroplasty. Orthopedics, 1989, 12(2): 231-239.
6. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res, 1990, (257): 107-128.
7. Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury, 2007, 38(6): 651-654.
8. Miettinen SSA, Mäkinen TJ, Kostensalo I, et al. Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty. Acta Orthopaedica, 2016, 87(2): 1-7.
9. Masri BA, Meek RM, Duncan CP. Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res, 2004, (420): 80-95.
10. Miettinen SS, Mäkinen TJ, Kostensalo I, et al. Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty. Acta Orthopaedica, 2016, 87(2): 1.
11. Tsiridis E, Pavlou G, Venkatesh R, et al. Periprosthetic femoral fractures around hip arthroplasty: current concepts in their management. Hip Int, 2009, 19(2): 75-86.
12. 王建云, 姜世平, 何健飞, 等. 形状记忆合金环抱器或钛捆绑带治疗髋关节置换术后股骨假体周围骨折. 中国骨与关节损伤杂志, 2007, 22(5): 400-401.
13. Munro JT, Garbuz DS, Masri BA, et al. Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures. Clin Orthop Relat Res, 2014, 472(2): 590-598.
14. García-Rey E, García-Cimbrelo E, Cruz-Pardos A, et al. Increase of Cortical Bone After a Cementless Long Stem in Periprosthetic Fractures. Clin Orthop Relat Res, 2013, 471(12): 3912-3921.
15. Zhang Z, Zhuo Q, Chai W, et al. Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty. Medicine (Baltimore), 2016, 95(35): e4751.
16. Fleischman AN, Chen AF. Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls. Ann Transl Med, 2015, 3(16): 234.

Chinese Journal of Reparative and Reconstructive Surgery

Mid-term effectiveness of cerclage wires fixation in treatment of periprosthetic femoral fractures associated with primary hip arthroplasty

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