Bethea et al classified proximal femoral fractures in patients who have had a total hip arthroplasty on the same side. The authors are from the Atlanta VA Hospital, Emory University and two community practices in Atlanta and San Francisco.
Location of Fracture
Type
distal to stem tip (in femoral diaphysis)
A
spiral around stem in the proximal femur
B
comminuted about the stem
C
Risk factors for fracture:
(1) trauma
(2) longitudinal fractures associated with placement of the prosthesis or recurrent dislocations of the prosthesis
(3) underlying bone disease (osteoporosis, Gaucher's disease)
(4) previous surgical revisions
(5) loosening of the prosthesis
Many patients had signs or symptoms prior to the fracture. These patients may be candidates for preventive interventions.
Type
Management Issues
A
may require revision with a long stem prosthesis or internal fixation; nonunion may occur with conservative therapy if multiple previous operations done on femur, poor bone stock, and/or improper alignment
B
loosening of hip prosthesis may occur if treated conservatively
C
immediate fixation recommended for early mobilization; usually require revision with a long stem prosthesis
For patients undergoing revision surgery, attention should be paid to:
(1) proper apposition of fracture fragments
(2) good cement technique at the proximal femur
(3) bone grafting
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