Tuesday 15 December 2009

perprosthetic fracture in a octogenarian-



perioprosthetic fracture in an 89 yr old male after Austin moore prosthesis implanted 3 years ago. COPD, H/0 recent CVA.


Ideally I want an implant which is cemented distallt and uncemented proximally for fractur healing and immediate mobilisation in view of his age. What was done was a fully porocoated cobalt chrome implant here in the porocoat was removed with a burr smoothen the stem for cementing distally and wiring proximally in the uncemented part. Patient was mobilised immediated post op with a walker wt bearing as comfortable. He is 8 months postop so far with no lysis. bipolar head used as the acetabulum was normal and low demand.

Hey I did a Restoration fluted stem revision yesterday- which may be an option here as it is titanium. fluted with grooves like wagner to fit distally and HA coated proximally for this octogenarian for immediate wt. bearing.
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4 comments:

  1. Dr. Utkarsh Kshatri15 December 2009 at 22:41

    Dear Dr. Jacob,
    Interesting case.
    Since it is a periprosthetic fracture, Removal of the loose A.M. Prosthesis is mandatory. Encirclage wiring or cable fixation at the long spiral fracture of femur and uncemented fully porous coated long stem fixation, the tip of which should be going fairly beyond the lowermost part of fracture is desirable.
    Head can be used Bipolar or hastings head if the acetabular surface is good. If acetabular surface is eroded than an uncemented cup with metal head and poly liner would be my choice.
    Do let us know what has been done. It will give us newer ideas and improve our modality of treating such cases.

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  2. Dr. Utkarsh Kshatri15 December 2009 at 22:47

    Removal of implant, encirclage wiring, long uncemented fully porous coated stem with tip extending fairly beyound fracture should be fixed on femoral side. If acetabular side eroded uncemented cup with poly liner and metal head is my choice.
    interesting case. please let us know what was done.

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  3. Harish6 February 2010 at 12:23

    Mr Varghese,

    This is still loading proximally as well; through calcar. Cannulok ( distally locked HA coated stem with hemi/bipolar or total head options) is what I prefer

    Harish Kurup
    UK

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    Replies
    1. Dr Jacob Varghese20 November 2020 at 08:43

      the colar if distal fitting and tigth does not load as per dexa studies we did a few years ago. the only advantage of cement dstally is immediate full wt bearing in an ostegenarian the fracture can heal to the stem and need not wait to unite to shaft. we have 8 year results in low demand pts in only 2 cases for same., 2 small nos to be sure

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