Survival of ceramic bearings in total hip replacement after high-energy trauma and periprosthetic acetabular fracture

Periprosthetic fractures of the acetabulum during cup insertion: posterior column stability is crucial

Periprosthetic hip fractures around acetabular components are rare with little information available to guide surgical management of these complex injuries. A retrospective review of intraoperative isolated acetabular periprosthetic fractures from three tertiary surgical units was done. A total of 32 patients were identified with 9 initially missed. Acetabular components were stable (type 1) in 11 patients with no failures; unstable (type 2) in 12 patients and treated with supplemental fixation. Non-union and displacement were correlated with absent posterior column plating. Missed fractures (type 3) had the highest reoperation rate. Anterior patterns all healed, whereas fractures with posterior column instability had a 67% failure rate. Periprosthetic acetabular fracture can heal successfully with posterior column stability. Plating is mandatory for large posterior wall fragments to achieve osteointegration.

Early failure of a non-cemented femoral stem after minimal-invasive total hip arthroplasty: cause analysis and classification

In this paper, we present a 77-year-old female patient with an early failure of a non-cemented femoral stem 6 months after implantation. We evaluate possible reasons for the implant failure in our case against the literature. Risk factors for stem failure include a BMI >30, varus implantation, a high femoral canal cortex ratio, and a small implant. It should be distinguished between modular and non-modular stems as well as cemented and non-cemented. Early failure would be <1 year postoperatively, late failure >1 year postoperatively. A classification of stem failure differentiating time and cause is suggested as this seems to be missing in the literature.