Results of operative treatment of periprosthetic femoral shaft fracture after total hip arthroplasty

Periprosthetic femoral shaft fracture represents an uncommon but potentiall y devastating complication associated with total hip arthroplasty. The trea tment should result in complete union of the fracture and at the same time guarantee stability of the implant. 15 patients treated between 1992 to 199 8 were analysed. Clinical and radiographic follow-up averaged 30 months (6- 79 months) in 13 cases. Two patients died regardless of the fracture. The m ethod of treatment depended on the intraoperative stability of the prosthes is and in addition on the fracture type (Bethea). In 5 cases of intraoperat ive stability of the prosthesis plate fixation was performed. Plate fixatio n was complicated by fixation failure combined with a recurrent fracture in two cases leading to shift to a long stem prosthesis. Ten cases of fractur es associated with loose stems were treated with a new prosthesis using a l ong stem system. In these cases an uncomplicated healing of the fracture wa s achieved with adequate stability in radiographic examinations. The averag e Harris score was 70 (26-93). For fractures near the femoral stem or in ca se of implant loosening we recommend the shift to a long stem prosthesis. A lso in fractures distally from the femoral stem tip we prefer now long stem implants rather than plate fixation to avoid large exposure of the femoral shaft and resultant complications.