Periprosthetic femoral fractures: outcome after treatment with LISS internal fixation or stem replacement in 36 patients.

Periprosthetic fractures of the femur present a challenging surgical problem. The aim of this study was to evaluate the outcome of periprosthetic femoral fractures (PFF) which were treated with internal fixation or stem revision. Depending on the fracture type in the Duncan-Vancouver-Classification, 42 patients with PFF were treated either with a Fixateur interne (n = 23) in cases with type B1 or C fractures, or with stem revision (n = 19) in cases with type B2/B3 fractures. Follow-up rate was 78% over 24 months. All but two fractures showed radiological signs of healing. Implant failure was noted in 4 cases in the LISS group. The Lysholm and Larson scores were respectively 75.5 and 71 in patients undergoing stem revision, versus 74.5 and 69 in those treated with LISS fixation. Even taking into account the higher risk of implant failure, the treatment with LISS internal fixation has shown to be a reasonable method in the treatment of periprosthetic fractures without stem loosening.