Component exchange in treatment of periprosthetic femoral fractures.

A retrospective analysis of 893 consecutive periprosthetic femoral fractures treated between 1976 and 2001 shows that component exchange with reimplantation of a cemented long-stem implant can be considered a reliable method of treatment with good functional results and low rates of complications (10%) and revision (7.5%). The possibility of increasing the degree of weight bearing postoperatively at an early stage or even immediate full weight bearing (25%) greatly facilitates mobilization of the mostly elderly and fragile patients. Evaluation according to the Harris Hip Score of the operation and rehabilitation results of a representative sample of 120 patients shows an average value of 85 after a mean period of 6.4 years. The patients' own rating is correspondingly high. In the authors' view, stem exchange is currently the method of choice in the majority of cases because of the rather high rate of stem loosening (77%) at the time of operation, the age-related frequently poor quality or loss of bone substance, and the possibility that the implant material may be damaged. The fact that more than one third of the fractures occurred without significant trauma underlines the importance of this injury as a possible sign of previously unrecognized osteolysis and weakening of the bone as a result of loosening of the prosthesis stem.