Original ArticleEarly results of the LPS™ limb preservation system in the management of periprosthetic femoral fractures
Introduction
Achieving skeletal fixation in the presence of progressive bone loss is a surgical challenge in patients following multiple revision arthroplasties, periprosthetic infection, malignancy or extensive limb trauma.1, 2, 3, 4 Periprosthetic femoral fractures (PPF) are a potentially devastating complication following total hip arthroplasty. Unpredictable fracture patterns and preexisting bone loss frequently combine in this patient group where medical comorbidities are also common.5 Their reported incidence in the literature ranges from 1% to 4.1% intraoperatively.6, 7, 8 The postoperative fracture risk has been described as 1% during the subsequent life of the implant.9 Patients who suffer PPF experience higher postoperative mortality rates of 7.3%10 and 11.0%11 within 6 months and one year, respectively.
A variety of alternative reconstructive options are available to address advanced femoral bone loss including impaction allografting, allograft-prosthetic composite (APC) and megaprosthetic arthroplasty. Modern megaprostheses are modular, allow extensive resections and are available with porous coated or cemented fixation. Megaprosthetic arthroplasty while technically demanding allows for immediate mobilisation and shorter periods of rehabilitation, avoiding the risk of disease transmission and graft incorporation associated with allografts.12 These reconstructions however are frequently complicated by dislocation, loosening and infection which can adversely affect limb function and prosthetic longevity.13, 14, 15 The purpose of our study was to assess the clinical outcomes of a cohort of megaprostheses performed for PPF by a single surgeon at our institution.
Section snippets
Methods
In July 2013, the Depuy Limb Preservation System (LPS™) was introduced at GUH. The LPS includes metaphyseal segments bearing articular surfaces for proximal and distal femoral replacements, diaphyseal anchor segments allowing cemented or cementless fixation and intercalary segments which allows prosthetic lengthening in 5 mm increments (Fig. 1).
Between July 2013 and November 2015, 23 patients underwent endoprosthetic femoral replacement of which 16 were performed for PPF or bone loss.
Results
Between July 2013 and November 2015, 23 patients underwent endoprosthetic femoral replacement of which 16 were performed for PPF or bone loss. The PPF cohort consisted of 9 males and 7 females with a mean age of 75 years (range 59–94). Surgery was indicated in those with poor proximal bone stock in combination with a Vancouver B1, B2, B3 and C fracture patterns (Fig. 2).
As indicated in Table 2, the majority of femoral stems revised in the PPF cohort were cemented, with only two uncemented stems
Discussion
Reconstruction options when faced with significant proximal femoral bone loss in complicated revision arthroplasty include APC – allograft-prosthetic composites14, 15 insertion of a megaprosthesis16, 17 or resection arthroplasty.18 Resection arthroplasty is employed as a last resort in cases of intractable pain, limb shortening and significantly impaired functional ability.19 APC conserves bone stock for future procedures and as such, is reserved for young, active patients, where appropriate.
Conflicts of interest
The authors have none to declare.
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