Surgical management of intra- and postoperative fractures of the femur about the tip of the stem in total hip arthroplasty.

Six techniques for the surgical management of fractures of the femur about the tip of the stem of a total hip arthroplasty were evaluated. Seven embalmed human femurs were prepared to receive the correct-size femoral component of a total hip system. A transverse osteotomy was performed at the level of the tip of the stem. Stability and strength of each reconstruction were tested on each femur under semidynamic loading conditions. This study showed that cementless revision to a long-stem prosthesis does not provide adequate stability. The highest strength and stability were achieved by supplementing the long-stem conversion with allograft struts and cable cerclage. Good results were obtained by lateral compression plating with unicortical screws proximally. Failure was due to pull-out of the proximal screws.