Cable plating with a single strut allograft in the treatment of periprosthetic fractures of the femur

Abstract

Background: Hip arthroplasties are increasing worldwide resulting in an increasing number of periprosthetic fractures. These fractures are difficult to treat with various the different fixation or revision options described, many of which have high complication rates. Purpose: To investigate whether our described method of treating periprosthetic fractures is an effective, safe and reproducible method of treating patients. Methods: We describe the largest series of a cable plate fixation system combined with a single cortical strut allograft to treat patients with periprosthetic fractures of the hip (Unified Classification System B1 and selected B2, C and D). Results: Between July 2006 and March 2015, 28 patients were treated using this method. The mean follow-up was 2.2 years (3 months to 9 years). The mean Oxford Hip Score (OHS) at final follow-up was 32 and the mean modified Harris Hip Score (mHHS) 67. There were 3 complications including 1 failure that required revision surgery, 1 case of infection successfully treated with debridement, antibiotics and retention, and a case of discomfort from the metalwork which we managed conservatively. Conclusion: This method of anatomical restoration of the femur with dual-plane fixation is a highly effective method of treating this complex group of patients, and should be considered as a first line of treatment. It shows that there is a role for successful treatment with internal fixation of certain B2, C and D fractures with this technique.