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Arthroplasty for Fractures

The role of joint replacement for fractures continues to expand.

Old hat now is hemiarthroplasty for neck of femur fractures.  Initially a prosthesis designed by Austin Moore in the 1940’s was the first off the shelf body replacement part in the world.  Now, the more common approach is to do a bipolar or even a total hip replacement, the arguments are about surgical approaches that modify the risk required ratio.
On the other side of the hip joint is the pelvis – with the socket of the hip joint.  Some patients injure this pelvic side of the hip –  putting the fragments together and holding the position with plates and screws is the standard treatment.  But in older patients, the bone quality is poor, the joint surfaces too damaged, and a complex hip replacement might be better.  I?ts a bigger deals than a normal hip replacement, and a bigger deal than a normal fractured hip, but it should allow full weight bearing, and an easier period of rehabilitation.
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This Xray shows a hip replacement augmented with a cage, screws, and bone graft to help pelvis heal as quickly as possible, and prevent the new socket from migrating into the pelvis.  It allows the patient to walk with as much weight through that leg as they like.
In the knee example, the common fracture treatment is putting the fragments back in position, augmenting with bone grafting, then holding it position with plates and screws.  The rehabilitation is a challenge, normal full weight bearing without supports should be possible at three months from injury.  That’s a long time if the outcome is uncertain, or if the knee is already arthritic.
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This example with a relatively subtle fracture, but arthritis severe enough to require a substantial walking aid.  The knee replacement includes a longer stem in the tibia and additional metal “augment” on the left side of the screen replacing the smashed bone.  The other situation emerging is with difficult fracture of the distal femur, where stability of the limb is better with a hinged knee replacement.

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