Treatment And Curative Effect Analysis Of Femoral Periprosthetic Fractures After Artificial Hip Joint Replacement

Objective: To explore the treatment and curative effect of femoral periprosthetic fractures after artificial hip joint replacement.Materials and Methods: The data of 31 patients(32 hips)with PFF after total hip arthroplasty from January 2013 to January 2019 were analyzed retrospectively.The average age of the patients was(67.38 ± 13.25)years.There were 13 males and 18 females.The causes of the initial replacement were femoral neck fracture in 19 cases,avascular necrosis of the femoral head in 9 cases,developmental dislocation of the hip in 3 cases and intertrochanteric fracture in 1 case.The trauma mechanism of fracture includes 27 hips with low energy trauma,2 hips with high energy trauma and 3 hips without obvious trauma.28 hips after primary replacement and 4 hips after revision.15 hips were fixed with bone cement and 17 hips with biological fixation.16 hips on the left,16 on the right,28 after THA and 4 after HA.Vancouver was used to classify the fractures,including 2 hips of type A,8 hips of type B1,13 hips of type B2,5 hips of type B3 and 4 hips of type C.There were 7 ASA grade II,22 ASA grade III and 2 ASA grade IV.There were 14 cases of hypertension,3 cases of diabetes,18 cases of osteoporosis,4 cases of chronic bronchopneumonia and 1 case of uremia.The interval between fracture and hip replacement was(49.05 ± 61.29)months.For different types,conservative,open reduction and internal fixation,revision of hip joint and other different treatment methods were adopted.The operative time,intraoperative and postoperative blood loss,blood transfusion,hospital stay,fracture healing time,Harris score,VAS score and complications were recorded.Results: Among 31 patients(32 hips),2 patients(including 1 type C fracture and 1 type B3 fracture)lost the follow-up,the rate of which was 9.3%.29 patients(30 hips)were followed up for 8-80 months,with an average follow-up time of(38.4 ± 26.69)months.During the follow-up,3 cases(10.3%)died,including 1 case of each type B2,B3 and C fracture.One case of AG type fracture was treated conservatively.30 patients(31 hips)were operated on.The operation time was 60-325 min,the average was(173.54 ± 81.67)min,the intraoperative blood loss was 100-2800 ml,the average was(771.27 ± 836.21)ml,the postoperative blood loss was 50-750 ml,the average was(222.67 ± 137.29)ml,the blood transfusion was 0-1800 ml,the average was(645.27 ± 541.99)ml,and the average hospital stay days of 31 patients(32 hips)were(18.1 ± 10.68)days.At the last follow-up,26 cases(27 hips)were followed up.The average Harris score of hip joint was(89.07 ± 4.78),of which the highest was(92.00 ± 4.24)for type C fracture and the lowest was(84.00 ± 6.00)for type B3 fracture.Excellent in 12 cases,good in 14 cases,moderate in 1 case.There was no significant difference in the Harris score between different fracture types.The walking function of the patients was 88.46% and 11.54% respectively.There were 23 cases without claudication(88.46%),2 cases with mild claudication(7.69%),and 1 case with moderate claudication(3.85%).Walking distance: 1 case(3.85%)was limited to indoor activities,4 cases(15.38%)were within 500 m,13 cases(50%)were more than 1km,8 cases(30.77%)were unlimited.After the operation,7 patients(26.92%)recovered to their original work,14 patients(53.85%)could do light physical work from daily work,4 patients(15.38%)could do self-care in daily life,and 1 patient(3.85%)had poor self-care ability.The average VAS score was(1.37 ± 1.42).11 hips(40.74%)had no pain,14 hips(51.85%)had slight pain when walking,2 hips(7.41%)had moderate pain when walking,and occasionally took non steroidal anti-inflammatory and analgesic drugs.Among them,the VAS score of type B1 fracture is the lowest(0.44 ± 0.88),and the VAS score of type B3 fracture is the highest(2.67 ± 1.15).There is a statistically significant difference.26 cases(27 hips)were healed.The average time of fracture healing was(4.25 ± 1.16)months(3-7months).The healing time of type a fracture was the shortest(2.50 ± 0.71)months,and that of type B3 fracture was the longest(5.67 ±1.54)months.Among them,there were significant statistical differences between type A fractures,type B2 fractures(P = 0.02)and type B3 fractures(P = 0.002).There is a statistically significant difference between type B1 and B3 fractures(P = 0.021),and between type B3 and C fractures(P = 0.028).Due to the limited number of cases,the Harris score of hip joint after operation was compared between steel wire fixation and steel plate combined with steel wire or strap fixation.The results showed that there was no significant statistical difference(P > 0.05).In type B2 fracture,Harris score,VAS score and fracture healing time of hip joint were compared between steel wire cable fixation and homologous cortical bone plate combined with steel wire cable fixation and locking plate,homologous cortical bone plate combined with steel wire cable fixation,there was no significant difference in Harris score,VAS score and healing time of type B2 fracture with different internal fixation methods(P > 0.05).There was no neurovascular injury during the operation.One case of deep vein thrombosis of lower extremity was treated by anticoagulation.Another patient had limited flexion of knee joint and abnormal walking gait,but did not affect the walking and walking distance.There was no nonunion or failure of internal fixation.Conclusion: 1.The treatment strategy of periprosthetic fracture after hip arthroplasty should consider fracture location,prosthesis stability,bone defect degree,patient's age,physical condition and economic condition.2.According to the different Vancouver classification,the corresponding treatment can achieve satisfactory results.3.Periprosthetic fracture of femur after hip replacement is related to many risk factors.For the elderly patients after hip replacement,it is suggested to actively treat osteoporosis and prevent falls.