Revision Total Hip replacement: Direct exchange Link MP revision stem for periprosthetic fracture
Subscribe to get full access to this operation and the extensive Hip Surgery Atlas.
Learn the Revision Total Hip replacement: Direct exchange Link MP revision stem for periprosthetic fracture surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Revision Total Hip replacement: Direct exchange Link MP revision stem for periprosthetic fracture surgical procedure.
Intra-operative fracture rates during total hip replacement have been reported as high as 7% which is a disappointing figure but simply reflects the strength of implants and instrumentation compared to the relative weakness of adult bone. Some cases are potentially avoidable but even an experienced surgeon following best practices and excercising all his or her skill will inevitably encounter such events and should be in a position to manage them.
To avoid iatrogenic peri-prosthetic fractures fractures I would strongly suggest always carefully templating pre-surgery as well as being entirely familiar with the implant. If intra-operatively trial sizes are going significantly above those that have been templated or following some resistance to rasping there is a suddenly easy passage of the rasp it is beholdent upon the surgeon to consider the possibility of an iatrogenic fracture and proceed appropriately.
I would recommend exploring the femur (as detailed in this technique) following the use of intraoperative radiographs if a femoral fracture is confirmed.
The Vancouver classification for intra-operative fractures is a logical descriptor which reliably guides the management of these complex and technically challenging injuries, though its preferable not to need to refer to it too often during a primary joint replacements.
The Vancouver Classification for Intraoperative fractures is, like its postoperative counterpart, logical. It classifies the area of fracture as being either proximal metaphysis (A), proximal diaphysis (B) or as being distal to the implant (C). Each of these areas is also subdivided into 1, 2 and 3 representing a cortical perforation, an undisplaced crack or a displaced fracture respectively.
This technique demonstrates the use of the MP stem (Link) for an acute peri-prosthetic femoral fracture of a total hip replacement. The MP stem is a modular, cementless stem with a porous finish allowing bony on-growth. Leg length, offset and version adjustments are all possible with this versatile system.
Within this presentation the Vancouver intraoperative periprosthetic fracture classification is discussed in detail along with principles of peri-prosthetic fracture exposure, implant removal, fracture reduction and maintenance of the femoral fracture. I also discuss methods of achieving leg length and stability after direct exchange.
Author:Mr Andrew Gordon PhD, FRCS (Tr & Orth)
Institution: The Northern General Hospital, Sheffield, UK
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.