What is a Periprosthetic Fracture?
Periprosthetic fractures are fractures or breaks of bone associated with an orthopedic implant, whether it is a joint replacement or internal fixation device. Periprosthetic fractures normally occur with implants associated with a hip, knee, shoulder, or elbow joint replacement. It is a major complication that most often requires surgical intervention. Globally, the incidence of periprosthetic fractures is increasing, due to the growing number of revision surgeries and joint arthroplasties.
Causes of Periprosthetic Fractures
Periprosthetic fractures occur often as the result of a fall. These fractures can also occur due to a direct blow or in a motor vehicle collision. Other risk factors for periprosthetic fracture include :
- Muscle weakness
- Poor balance and vision
- Loosened femoral stem of the implant due to wear and tear
- Thinning of the bone, known as osteolysis
- Rheumatoid arthritis
- Advanced age
Signs and Symptoms of Periprosthetic Fractures
Some of the common signs and symptoms of periprosthetic fractures include :
- Swelling and bruising
- Inability to bear the weight
- Deformity or shortening of the injured leg
Diagnosing a Periprosthetic Fracture
Your doctor will review your symptoms and medical history and perform a physical examination. They will closely examine the affected region to assess the range of motion. Imaging tests such as X-rays will be ordered to study the complexities of the fracture, including the quality of the bone, fragments of the broken bone, and the extent of bone displacement. CT scans may also be ordered for a detailed examination of bony structures and soft tissues. Blood and other laboratory tests may be ordered to obtain additional information.
Treatment of a Periprosthetic Fracture
Most cases of periprosthetic fracture require surgery. Several factors are considered to establish the right treatment for you, including :
- The quality of the remaining bone
- The location and type of fracture
- The condition of the implant
- Your overall medical health
The normal treatment approaches include :
- Revision of the total joint implants
- Open reduction and internal fixation (ORIF)
- A combination of both of the above
Joint Revision : The stem of the implant is found to be loose in some cases of periprosthetic fractures. Under these circumstances, the original implant should be separated from the bone and restored with a new implant. This procedure is known as joint revision.
Open Reduction and Internal Fixation : In situations where your implant is firmly attached to the bone, your physician may recommend internal fixation to manage the fracture. During this method, the fragments of bone are repositioned into their normal alignment and then held together with cables, metal plates, and special screws to the outer surface of the bone.
In certain cases, a bone graft is used to assist the fractured bone to heal. Bone grafting involves transplanting bone tissue to support parts of the weakened bone. Bone tissue from a deceased donor is commonly used for treating periprosthetic fractures.