Periprosthetic Femoral Fractures

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after January 30, 2024:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.25
Procedures: 0.25
Head, Spine, and Musculoskeletal: 0.25

Radiography: 0.50
Procedures: 0.50
Head, Spine and Pelvis Procedures: 0.50

Registered Radiologist Assistant: 0.50
Procedures: 0.50
Musculoskeletal and Endocrine Sections: 0.50

Outline

1. Introduction
2. Evaluation of Hip Prostheses in the ED
3. Common Prostheses and Expected Radiographic Appearance
4. Fracture Risk and Etiology
5. Vancouver Classification System
   1. Fracture Location
   2. Prosthesis Stability
      1. Traumatic Loosening
      2. Atraumatic Loosening
   3. Quality of Femoral Bone Stock
      1. Severity of Bone Loss
      2. Location of Bone Loss
6. Application of the Vancouver Classification: Clinical Examples and Management Implications
   1. Patient 1
      1. Discussion
   2. Patient 2
      1. Discussion
   3. Patient 3
      1. Discussion
   4. Patient 4
      1. Discussion
   5. Patient 5
      1. Discussion
7. Limitations of the Vancouver Classification System
8. Conclusion

Objectives

Upon completion of this course, students will:

1. understand the factors contributing to an increase in the number of THAs performed annually
2. know the strongest negative prognostic indicator for postrevision arthroplasty
3. know the optimum strategy for evaluating periprosthetic fractures
4. know the optimum strategy for managing periprosthetic fractures
5. be familiar with the role of radiography in patients with THA who present with hip pain
6. understand the role of nonenhanced MDCT of the hip in patients with THA
7. know what factors may hinder nonenhanced MDCT In the setting of a femoral prosthesis
8. understand what stress shielding is
9. be familiar with the radiographic appearance of press-fit hip prostheses
10. be familiar with the radiographic appearance of cemented hip prostheses
11. know the most common risk factors associated with postoperative periprosthetic fractures
12. know the causes of hip prosthesis loosening
13. understand when an implant is considered stable
14. understand when an implant is considered unstable
15. be familiar with the major radiographic characteristics used by the Vancouver classification
16. be familiar with the three anatomic zones used in the Vancouver classification system to characterize fracture location
17. describe the features of a Vancouver AGT periprosthetic fracture
18. describe the features of a Vancouver ALT periprosthetic fracture
19. understand why Vancouver A periprosthetic fractures are treated conservatively
20. describe the features of a Vancouver B1 periprosthetic fracture
21. describe the features of a Vancouver B2 periprosthetic fracture
22. describe the features of a Vancouver B3 periprosthetic fracture
23. describe the features of a Vancouver C periprosthetic fracture
24. list the three mechanisms that can cause disruption of the periprosthetic fixation interface
25. know the indications for atraumatic loosening for cemented prostheses
26. know the indications for atraumatic loosening for press-fit prostheses
27. be familiar with why high-quality femoral bone stock is important
28. know the findings that are indicative of severe bone loss
29. know the findings that are indicative of nonsupportive bone
30. understand the importance of describing the distribution of bone loss in patients with a loose prosthesis and bone loss
31. know the percentage of periprosthetic femoral fractures that are classified as Vancouver B1
32. know the percentage of periprosthetic femoral fractures that are located along the femoral stem
33. be familiar with the clinical presentation of the five patients discussed in the article
34. understand the treatment rationale for the five patients discussed in the article
35. be familiar with the standard of reference for loosening and poor bone stock when assessing a femoral prosthesis