Fractures can occur after a hip or knee replacement. When this occurs, it is known as a peri-prosthetic fracture. A peri-prosthetic fracture involves the bone around the prosthesis and is a serious complication that most often requires surgery. Peri-prosthetic fractures after total knee arthroplasty or total hip arthroplasty can be challenging for many orthopaedic surgeons because patients are older and may have thinning bone or other medical conditions. However, Dr Ackermann has particular expertise in this type of revision surgery.
The aim for treatment of peri-prosthetic fractures is to relieve pain and stabilise the knee or hip joint with as little misalignment of the joint possible. Treatment of this kind of fracture will depend entirely on the degree of damage, the quality of bone remaining and the physical condition of the patient. Treatment is thus completing tailored to the patient and will vary accordingly.
In cases where non-surgical treatment is deemed sufficient, a peri-prosthetic knee fracture will be treated with a hinged cast brace and restricted weight bearing on the injured knee. In more severe cases, operative treatment may involve osteosynthesis with or without bone graft if the prosthesis is stable. Open reduction and internal fixation may be used to keep the prosthesis in place. In cases where the prosthesis is out of place, a revision knee replacement surgery will be needed.
Due to the location of the fracture, bracing of the hip joint isn't possible after a peri-prosthetic fracture. Most cases of peri-prosthetic hip fractures require surgery. Depending on the type and location of the fracture, a peri-prosthetic hip fracture will be treated with open reduction and internal fixation, revision hip replacement surgery or both of these techniques.
Open reduction and internal fixation may be done to firstly reduce or remove any loose fragments of bone within the joint and secondly to secure the prosthesis to the bone with screws or plates. In some cases, a bone graft may be needed to enhance the recovery of the broken bone.
In some cases, where the prosthesis is loose after a fracture, you may require joint revision surgery.