The worst-case scenario: treatment of periprosthetic femoral fracture with coexistent periprosthetic infection—a prospective and consecutive clinical study

Background

The simultaneous occurrence of periprosthetic fracture (PPF) and periprosthetic joint infection (PJI) is among the most devastating complications in arthroplasty and carries the risk of limb loss. For the first time, this study will describe the characteristics, treatment concepts, and outcomes of this complication.

Methods

Patients were consecutively included who were treated at our specialized interdisciplinary department between 2015 and 2016 with a PJI and an additional PPF of the hip. The treatment algorithm followed a three-step procedure: the complete removal of any foreign material (step 1), fracture stabilization by plate, intramedullary rod osteosynthesis or cerclages using an additional spacer (step 2), and reimplantation of a new prosthesis (step 3).

Results

Overall, eight cases [four male, four female, mean age 77 years (55–91)] were included. The mean follow-up was 34 ± 8 months. The fractures included one PPF Vancouver B1, three B2/3, and four type C. Most frequent microbes were CNS (Coagulase-negative staphylococci) (n = 4), Cutibacterium (n = 2) and Staphylococcus aureus (n = 2). Mixed infections (≥ 2 microorganisms) occurred in five cases. The time between explanation and reimplantation was 42 ± 34 (range 7–123) days. A re-infection took place in one, a re-revision in four cases, and in five cases fracture healing was noticed. In all eight cases, freedom from the infection and limb preservation could be achieved.

Conclusion

PPF in the case of a PJI is a devastating situation and a huge challenge. Extremity preservation should be the primary goal. The described procedure offers a possible solution.