A study of periprosthetic fractures following hemi-arthroplasty of hip in elderly population: diagnosis and management

Background: Hemi-arthroplasty of hip for intracapsular fractures of femoral neck is one of the most commonly done surgical procedures in the low mobility older Indian population. Although there are numerous complications associated with the procedure, we want to study the types and management of peri-prosthetic fractures in patients treated with hip hemi-arthroplasty.Methods: A total of 26 patients were included in the study. A retrospective analysis of the radiological cum clinical diagnosis and management of peri-prosthetic fractures was performed. All patients were followed up till 1.5 years post-operatively.Results: According to Vancouver classification of peri-prosthetic fractures, 10 fractures were classified as type A, 7 as type B1, 3 as type B2, 4 as type B3 and 2 as type C. Fractures were managed either by Open Reduction with Internal Fixation (ORIF) or Revision hemi-arthroplasty. Fractures type AG, B1 and C were managed with ORIF and type B2 and B3 fractures were managed with revision hemi-arthroplasty using longer stem.Conclusions: As evident in our study, majority of fractures occurred intra-operatively, a thorough evaluation of pre-operative x-rays of both hips should be done along with special focus on anatomical variations. Correct diagnosis based on radiological and intraoperative findings followed by appropriate treatment are of paramount importance in the management of peri-prosthetic fractures