Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report

Hiroyuki Hatanaka; Goro Motomura; Satoshi Ikemura; Kazuhiko Sonoda; Yusuke Kubo; Takeshi Utsunomiya; Takuaki Yamamoto; Yasuharu Nakashima

doi:10.1016/j.ijscr.2017.06.010

Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report

Int J Surg Case Rep. 2017:37:65-68. doi: 10.1016/j.ijscr.2017.06.010. Epub 2017 Jun 13.

Authors

Hiroyuki Hatanaka¹, Goro Motomura², Satoshi Ikemura¹, Kazuhiko Sonoda¹, Yusuke Kubo¹, Takeshi Utsunomiya¹, Takuaki Yamamoto³, Yasuharu Nakashima¹

Affiliations

¹ Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
² Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Electronic address: goromoto@ortho.med.kyushu-u.ac.jp.
³ Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, 12 Jonan-ku, Fukuoka 814-0180, Japan.

Abstract

Introduction: The thrust plate hip prosthesis (TPP; Zimmer, Winterthur, Switzerland) is a hip prosthesis that is no longer in production. Few reports have focused on periprosthetic fractures following total hip arthroplasty (THA) with the use of a TPP.

Presentation of case: We report a 57-year-old woman with a periprosthetic femoral fracture 13 years after THA with the use of a TPP. A plain radiograph showed a displaced subtrochanteric fracture of the right femur just below the distal tip of the lateral plate without implant loosening. She underwent revision surgery with a long distally fixed intramedullary stem in conjunction with a plate and cable system. Three months after surgery, bone union was confirmed using radiography and the patient was clinically asymptomatic.

Discussion: We encountered three major problems while planning surgical treatment, these being, discontinuation of the TPP system, loss of proximal femoral cancellous bone, and difficulties with the type of subtrochanteric fracture. After considering these problems, we planned revision surgery using a long distally fixed intramedullary stem in conjunction with a plate and cable system.

Conclusion: This case shows that sufficient implant preparation based on precise preoperative planning is necessary to obtain good clinical results for the surgical treatment of periprosthetic femoral fractures following THA with the use of a TPP.

Keywords: Femoral head; Osteonecrosis; Periprosthetic femoral fracture; Thrust plate prosthesis; Total hip arthroplasty.