Failed internal fixation due to osteonecrosis following traumatic periprosthetic fracture after hip resurfacing arthroplasty

Figures & data

Figure 1.  A. Traumatic periprosthetic femoral neck fracture 18 weeks after the index procedure treated with cannulated cancellous screws. B. Collapse of the femoral neck (short arrow) led to marked dislocation of both the proximal femoral remnant and all 3 screws (long arrow). C. After the revision surgery with conversion to a femoral stemmed total hip replacement with extra-large femoral head.

Figure 2.  A. Well-fixed femoral component, narrow superficial zone of cement penetration, and irregular fracture line were apparent macroscopically on the cut plane. B. Absence of vital reaction to the screw was evident by contact radiography several weeks after the procedure. C. Cement granulomas and fibrosis were found at the bone-cement interface. D. Bone trabeculae without stainable osteocytes and precipitations of calcium salts were found in the vicinity of the screw and of the fracture line. E. Bone tissue fragments from femoral neck distally to the fracture line revealed several fractured individual bone trabeculae (long arrow) with formation of microcallus and focal resorptive changes (short arrow). F. Broad fracture callus within the isolated bone fragments from femoral neck distal to the fracture line.

  Overview of successful operative treatment of traumatic periprosthetic fracture after hip resurfacing arthroplasty

Age	Sex	Preoperative diagnosis	Time to fracture	Trauma	Fracture type	Therapy	Follow-up	Reference
32	F	posttraumatic arthritis	4 years	car accident	comminuted sub-trochanteric	contoured broad AO DCP	5 months	Whittingham-Jones (2008)
54	M	osteoarthritis	2 years	–	displaced inter-trochanteric	locking plate 3 screws	1 year	Orpen (2009)
54	M	osteoarthritis	3 months	fall from a ladder	multi-fragmented reverse oblique intertrochanteric	locking plate 3 screws	6 months	Orpen (2009)
67	M	osteoarthritis	19 months	fall on a hip	closed intertrochanteric	130°angled blade plate	17 months	Weinrauch (2008)
69	M	osteoarthritis	15 months	fall	undisplaced basicervical	3 cannulated cancellous screws	4 years	Mereddy (2008)
60	M	–	2 years	traffic accident	complex multifragmentary	2 locking screws cerclage wires	1 year	Aning (2005)