THA Periprosthetic Fractures

Question 1

What are risk factors for intra-operative acetabular fracture in THA?

Answer 1

underreaming >2mm
elliptical modular cups 
osteoporosis
cementless acetabular components
dysplasia
radiation

Question 2

What are risk factors for intra-operative femur fracture in THA?

Answer 2

impaction bone grafting
female gender
technical errors
cementless implants
osteoporosis
revision
minimally invasive techniques (controversial)

Question 3

During insertion of a cementless femoral stem, a nondisplaced fracture is noticed along the femoral calcar. What is the most appropriate next step in surgical management?

Answer 3

Removal of the stem, cerclage wiring around the fracture site, and insertion of a stem that bypasses the fracture by at least 2 cortical diameters of the femur

Question 4

What is the typical timing of failure for cemented and uncemented femurs in THA?

Answer 4

Uncemented- first 6 months

Cemented ~5 years

Question 5

What is the treatment for greater trochanter fracture in THA?

Answer 5

Non-displaced- protected weight bearing, abduction brace

Displaced- claw plate, wires or cables

Question 6

How are Vancouver B3 fractures treated in THA?

Answer 6

Young- revision with distal fit and allograft/plate

Old- proximal femoral replacement

Question 7

What is the classification for periprosthetic femur fractures in THA?

Answer 7

Vancouver:
AL- lesser troch fx
AG- greater troch fx
B- around the stem (1-stem stable, 2-unstable with adequate bone stock, 3-unstable with inadequate bone stock)
C- well distal to the stem