Femur Fractures in Patients With Hip Arthroplasty: Indications for Revision Arthroplasty

ABSTRACT: The number of periprosthetic femur fractures has increased due to the increase in  the number of patients having total hip arthroplasty. In this study, we define indications for  operative treatment in patients with femur fractures after hip arthroplasty. Fifty-three patients  with 56 periprosthetic fractures were available for retrospective review of charts, radiographs,  and physical examination; 42 fractures were treated with open reduction and internal fixation,  8 had replacement of hip prosthesis, 4 were treated with a retrograde genucephalic nail, and 2  patients were treated conservatively. The choice of treatment depended on the stability of the  prosthesis and on the type and location of the fracture. Fifty-two fractures healed primarily.  Three patients sustained a refracture, one an additional fracture, and two a deep infection. We  recommend treatment with plate fixation for fractures without signs of prosthetic loosening. In  ractures with loose implants, revision arthroplasty is required. Distal femoral fractures  should be stabilized with a plate or with genucephalic nailing.