Early complication of a subtrochanteric periprosthetic fracture following hip resurfacing. Is varus healing acceptable? A case report and literature review.

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Giovanni Lugani
Alessandro Santandrea
Leonardo Puddu
Massimo Rigoni
Fabrizio Cont
Bruno Magnan
Fabrizio Cortese


Hip resurfacing, Periprosthetic fractures, Subtrochanteric fractures


Background: The increase in the incidence of osteoarthritis of the hip (coxarthrosis) in young patients with high functionality requirements and the development of new materials in the last twenty years have resulted in an increase in the number of surgeries involving hip resurfacing procedures. There has also been an increase in associated periprosthetic fractures, which currently occur in 1%-2% of cases. According to the medical literature, fractures of this type can be treated conservatively, using reduction and synthesis or through prosthetic revision. Case report: Patient aged 69 years who had undergone resurfacing of the right hip ten years previously, who came to our attention as a result of direct contusion trauma with x-ray evidence of a periprosthetic fracture in the subtrochanteric region. We treated the fracture by preserving the prosthesis and performing osteosynthesis using a plate and screws. After two months the synthesis was complicated by breakage of a proximal screw and varus collapse of the fracture. We treated this complication conservatively by adjusting the weight-bearing regime and administering physical and drug therapy. Six months after the fracture, despite the residual varus displacement and the less than stellar x-ray result, the clinical outcome was satisfactory. Discussion and conclusions: Treatment of periprosthetic fractures following hip resurfacing is often technically complex. The major difficulties arise from the presence of prosthetic components and the limited bone stock available. Fractures often affect the neck of the femur and the trochanteric region, and in rare cases there is involvement of the subtrochanteric region. Our review confirms this trend and raises the question as to which method of synthesis is ideal for a fracture pattern so rarely described in the literature.


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1. Kohan L, Field CJ, Kerr DR. Early complications of hip resurfacing. J Arthroplasty. 2012 Jun;27(6):997-1002. doi: 10.1016/j.arth.2012.01.030. Epub 2012 Apr 13. PMID: 22503492.

2. Capone A, Congia S, Civinini R, Marongiu G. Periprosthetic fractures: epidemiology and current treatment. Clin Cases Miner Bone Metab. 2017 May-Aug;14(2):189-196. doi: 10.11138/ccmbm/2017.14.1.189. Epub 2017 Oct 25. PMID: 29263732; PMCID: PMC5726208.

3. Shimmin AJ, Back D. Femoral neck fractures following Birmingham hip resurfacing: a national review of 50 cases. J Bone Joint Surg Br. 2005 Apr;87(4):463-4. doi: 10.1302/0301-620X.87B4.15498. PMID: 15795193.

4. Richards CJ, Giannitsios D, Huk OL, Zukor DJ, Steffen T, Antoniou J. Risk of periprosthetic femoral neck fracture after hip resurfacing arthroplasty: valgus compared with anatomic alignment. A biomechanical and clinical analysis. J Bone Joint Surg Am. 2008 Aug;90 Suppl 3:96-101. doi: 10.2106/JBJS.H.00444. PMID: 18676943.

5. Amstutz, Harlan C., MD1; Campbell, Pat A., PhD1; Duff, Michel J. Le, MA1 Fracture of the neck of the femur after surface arthroplasty of the hip, JBJS: September 2004 - Volume 86 - Issue 9 - p 1874-1877

6. Aning, J., Aung, H., & Mackinnon, J. (2005). Fixation of a complex comminuted proximal femoral fracture in the presence of a Birmingham hip resurfacing prosthesis. Injury, 36(9), 1127-1129.

7. Banerjee, S., Little, T., & Little, N. (2015). Intramedullary fixation of pertrochanteric fractures after hip resurfacing arthroplasty–Do we have the answer? Case report and literature review. Journal of Orthopaedics, 12(2), 66-69.

8. Baxter, J. A., Krkovic, M., & Prakash, U. (2010). Intertrochanteric femoral fracture after hip resurfacing managed with a reverse distal femoral locking plate: a case report. Hip International, 20(4), 562-564.

9. Brennan, S. A., Devitt, B. M., O’Neill, C. J., & Nicholson, P. (2013). Periprosthetic fractures in the resurfaced hip—a case report and review of the literature. Injury, 44(2), 263-265.

10. Carpentier, K., & Govaers, K. (2012). Internal fixation of an intertrochanteric femoral fracture after Birmingham hip resurfacing arthroplasty. Acta Orthop Belg, 78(2), 275-278.

11. Cossey, A. J., Back, D. L., Shimmin, A., Young, D., & Spriggins, A. J. (2005). The non-operative management of periprosthetic fractures associated with the Birmingham hip resurfacing procedure. The Journal of Arthroplasty, 20(3), 358-361.

12. Cumming, D., & Fordyce, M. J. F. (2003). Non-operative management of a peri-prosthetic subcapital fracture after metal-on-metal Birmingham hip resurfacing. The Journal of Bone and Joint Surgery. British volume, 85(7), 1055-1056.

13. Fabbri, D., Orsini, R., & Moroni, A. (2018). Stress fracture of proximal femur after hip resurfacing treated with cannulated screw. Joints, 6(2), 128.

14. Koulischer, S., Devos, S., Verstraeten, P. B., Delahaut, O., & Muhadri, A. (2020). Internal fixation of an intertrochanteric fracture after resurfacing arthroplasty: a case report. Journal of Orthopaedic Case Reports, 9(6), 65.

15. Kutty, S., Pettit, P., & Powell, J. N. (2009). Intracapsular fracture of the proximal femur after hip resurfacing treated by cannulated screws. The Journal of Bone and Joint Surgery. British Volume, 91(8), 1100-1102.

16. Lein, T., Schlee, J., Kothe, M., Moritz, F., & Wubtaye, D. T. (2010). Periprosthetic intertrochanteric fracture of the femur following articular resurfacing of the hip joint: treatment with lag screw osteosynthesis. Der Unfallchirurg, 113(11), 944-950.

17. Macdonald, J., Robinson, A., & Brown, I. (2014). Fixation of a periprosthetic intertrochanteric hip fracture below a Birmingham hip resurfacing. Case reports in orthopedics, 2014.

18. Macdonald, J., Pagoti, R., & Cusick, L. (2017). Bilateral fixation of a periprosthetic intertrochanteric hip fracture below Birmingham hip resurfacing. Case Reports, 2017, bcr2016218840.

19. Matharu, G. S., McBryde, C. W., Revell, M. P., & Pynsent, P. B. (2013). Femoral neck fracture after Birmingham Hip Resurfacing Arthroplasty: prevalence, time to fracture, and outcome after revision. The Journal of Arthroplasty, 28(1), 147-153.

20. Mereddy, P., Malik, H., & Geary, N. (2009). Peri-prosthetic fracture neck of femur following metal-on-metal Birmingham hip resurfacing treated by internal fixation. Injury Extra, 40(4), 65-67.

21. Morgan, D., Myers, G., O? Dwyer, K., & Thomas, A. M. (2008). Intertrochanteric fracture below Birmingham Hip Resurfacing: Successful non-operative management in two cases. Injury Extra, 39(9), 313-315.

22. Orpen, N. M., Pearce, O., Deakin, M., & Keys, R. I. (2009). Internal fixation of trochanteric fractures of the hip after surface replacement. Injury Extra, 40(2), 32-35.

23. Peskun CJ, Townley JB, Schemitsch EH, Waddell JP, Whelan DB. Treatment of periprosthetic fractures around hip resurfacings with cephalomedullary nails. J Arthroplasty. 2012 Mar;27(3):494.e1-3. doi: 10.1016/j.arth.2011.06.018. Epub 2011 Aug 19. PMID: 21855278..

24. Sharma, H., Rana, B., Watson, C., Campbell, A. C., & Singh, B. J. (2005). Femoral neck fractures complicating metal-on-metal resurfaced hips: a report of 2 cases. Journal of Orthopaedic Surgery, 13(1), 69-72.

25. Shimmin AJ, Back D. Femoral neck fractures following Birmingham hip resurfacing: a national review of 50 cases. J Bone Joint Surg Br. 2005 Apr;87(4):463-4. doi: 10.1302/0301-620X.87B4.15498. PMID: 15795193.

26. Silk, G., Sangster, M., & Sandhu, H. (2011). Internal fixation of trochanteric fracture following hip resurfacing. Injury Extra, 42(11), 183-185.

27. Soin, S., El-Shaar, R., Taylor, A., & Ketz, J. (2020). Periprosthetic intertrochanteric fracture between hip resurfacing and retrograde nail. Arthroplasty Today, 6(4), 682-685.

28. Steffen, R. T., Foguet, P. R., Krikler, S. J., Gundle, R., Beard, D. J., & Murray, D. W. (2009). Femoral neck fractures after hip resurfacing. The Journal of Arthroplasty, 24(4), 614-619.

29. Weinrauch, P., & Krikler, S. (2008). Proximal femoral fracture after hip resurfacing managed with blade-plate fixation: a case report. JBJS, 90(6), 1345-1347.

30. Weusten, A. J., Khan, S. K., Bonczek, S. J., ElshArief, D., & Wallace, I. W. (2012). Internal fixation of a traumatic fracture around a hip resurfacing arthroplasty using the proximal femoral locking compression plate. Acta Orthopaedica Belgica, 78(5), 688.

31. Whittingham-Jones P, Charnley G, Francis J, Annapureddy S. Internal fixation after subtrochanteric femoral fracture after hip resurfacing arthroplasty. J Arthroplasty. 2010 Feb;25(2):334.e1-4. doi: 10.1016/j.arth.2008.10.015. Epub 2008 Dec 4. PMID: 19056223.

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