What is Periprosthetic fracture?
A periprosthetic fracture is one that occurs near an artificial joint, or in the case of hip, knee, or shoulder replacement. These fractures occur in the immediate vicinity of bone adjacent to the implanted prosthesis or through sites weakened by surgical intervention.
Many factors can contribute to periprosthetic fractures, including trauma, fall, increased stress on the joint, or osteoporotic bone. Periprosthetic fractures are a major complication in their own right, as their repair involves surgery, which may further compromise the stability and function of the prosthesis.
Surgical fixation with plates, screws, or revision of the prosthesis may be indicated, depending on the fracture’s location and severity. Timely diagnosis and appropriate management are indispensable in achieving good outcome results and returning function.
Symptoms of Periprosthetic fracture
The presentation of a periprosthetic fracture will depend upon the size and site of the fracture but typical presentations include:
- Extreme pain over the joint, usually an acute onset.
- It is impossible to move or weight-bear through the affected limb.
- Swelling and bruising of the joint.
- Deformity or abnormal alignment of the joint, particularly if the fracture is large.
- Instability or sense of looseness or shifting of the prosthesis, especially in weight-bearing joints such as the hip or knee.
- Painful limitation of range of motion or mechanical disruption of range of motion.
- Tenderness to touch or pressure at the fracture site.
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Causes of Periprosthetic Fractures
Periprosthetic fractures have several causes. Among them are
- Trauma or Injury: Falls, accidents or a joint being hit directly can lead to this kind of injury, especially when there is loss of bone support around the implant.
- Osteoporosis: Weakened bones subjected to less than optimal stress can easily break.
- Implant Failures or Loosening: Such time-dependent behavior of prosthetic implants usually increases the stress within the adjacent bone and eventually leads to fracture.
- Overuse or Repetitive Stresses: Overuse or repetitive stresses on the joint can contribute to stress fractures particularly for very high-level patients or abnormal loading on the joint.
- Defects or Weakening of Bone: This makes the bone surrounding the implant weak, and thus makes it very prone to fracture, because various defects such as previous bone diseases and cysts or concurrent pathologies speak to relative weakness of the structure.
- Surgical Factors: At times, it may happen that there are complications at the time of surgery; incorrect placement of the implant or over-manipulation of the bone predisposes it to fractures.
- Infection: Infection around the prosthesis can weaken the bone and surrounding tissues, making them more prone to fracturing.
Risks Associated with Periprosthetic Fractures
Periprosthetic fractures put patients at risk for several complications:
- Infection: Surgery to internally fix the fracture or swap out the imposed prosthesis may cause infection; this risk is especially relevant whenever any hardware is involved in the fixation process.
- Implant Loosening or Failure: A fracture may jeopardize prosthesis stability and cause what seems to be loosening or failure of the implant, which would subsequently require additional corrective surgery or revision of the joint replacement.
- Delayed Healing/Nonunion: In some instances, if the fracture fails to heal, delayed healing or nonunion may occur, necessitating extended treatment with a risk of additional surgeries.
- Immobility and Loss of Function: An impaired fracture can hinder the patient from moving the affected joint or bearing weight on it; such restrictions lead to chronic disability, dependence, and difficulty carrying out activities of daily living.
- Increased risk of Deep Vein Thrombosis: The surgical approach, immobility, and trauma raise the likelihood of blood clot formation within the veins and grave complications like pulmonary embolism.
- Chronic Pain: Some patients develop chronic pain in or around the joint, even in complete healing, especially if a fracture misaligned or malfunctions the prosthetic joint.
- Increased Risk of Future Fractures: Once a periprosthetic fracture occurs, the bone that frames the prosthesis remains weakened, thus putting the patient at a very high risk of another fracture.
- Anesthesia or Surgery-Related Complications: There are complications related to anesthesia, bleeding, or other surgical risks, similar to any sort of surgery, especially in the elderly or medically frail.
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Treatments for Periprosthetic Fractures
Management for periprosthetic fractures is determined by the classification, location, and severity of the fracture, as well as by the physiological condition of the patient and the durability of the implant. Approaches generally embrace:
- Conservative treatment: In case of small fractures, especially when the prosthesis is stable and the fracture is not majorly displaced, they would advise nonoperative means like rest, immobilization, perhaps pain management, or restriction of weight bearing until proven otherwise on healing.
- Surgical Treatment:
- Internal Fixation: In situations where stability is attained at the fracture site but healing will still take time, the surgeon will, through the prosthetic bone, insert plates, screws, or rods aimed at stabilizing the bone without interference with the prosthesis.
- Revision Surgery: If the prosthesis becomes loose or damaged, or if the fracture disrupts its stability, revision surgery is required. It is generally used for hip or knee fractures and involves replacing the prosthesis and repairing the fracture.
- Bone Grafting: In cases where there is extensive bony loss or large fractures, bone grafts can be used to facilitate healing process and provide structural support.
- Post-Surgery Rehabilitation: This commonly entails physiotherapy to regain joint mobility, strengthen musculature around the implant, and return the patient into rehabilitation after surgery.
- Weight Bearing Criteria: Patients may be told to avoid bearing weight for some time after being treated, most often based on the nature of the fracture as well as on the nature of the treatment adopted.
- Pain Management: It is an essential component of the treatment plan that is done via several methods through medications, anti-inflammatory drugs, or nerve blocks.
Conclusion
In summation, timely diagnosis and specialized treatment of periprosthetic fractures are of paramount importance for the best outcome achievable for patients. Whether by conservative measures or through highly advanced surgery, an effective management method is required for these fractures to carry joint mobility to people and, thus, enhance overall mobility.
Goyal Hospital Jaipur is where we aspire to build the benchmark for the best available care for all kinds of orthopedic conditions, encompassing periprosthetic fractures. With modern equipment and experienced surgeons, augmented by patient-centric approach, we aspire to be identified as the best hospital in Jaipur in providing orthopedic treatments.
Each of the patients is given personalized care according to the needs of the patients through a dedicated team which handles that emergency of care provision in every individual patient.
