Periprosthetic Fracture after Total Hip Arthroplasty

Description

Dr Jonathan Vigdorchik gives his insights whilst discussing periprosthetic fractures occurring after total hip arthroplasty, specifically highlighting the Vancouver classification system, which is crucial for determining treatment approaches. He details the three categories: B1 (well-fixed stem), B2 (loose stem), and B3 (loose stem with poor bone quality), providing insights on surgical strategies for each classification. In cases of B1 fractures, the femoral stem may remain unchanged, allowing for methods like open reduction and internal fixation with augmentation. For B2 fractures, the loose stem necessitates its removal, and fixation techniques are emphasized to ensure stability throughout the femur, possibly using a longer diaphyseal engaging stem to facilitate healing. The audio further outlines the challenges in achieving proximal fixation in the presence of large metal implants, advising surgeons on the importance of adequate screw fixation and the use of plates that extend up to the greater trochanter and down towards the knee. Lastly, it acknowledges the complexities involved in managing B3 fractures due to poor bone quality.

DOI: 10.1302/3114-251144

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