Revision arthroplasty with ORIF

It is important to reconstruct a stable hip joint and to achieve rigid stem fixation in the distal fragment. Restoration of leg length, alignment, and rotation are equally important.

The arthroplasty revision should be preferably addressed first to reconstruct a stable hip joint. Internal fixation is then performed to reestablish bone stock.

The surgeon should use the surgical approach that is the most familiar to him/her for any total hip arthroplasty.

Extensile approach is necessary to access the fracture site for exposure and removal of the prostheses, revision of prostheses, and reduction and placement of fixation devices, such as cerclage wires, cables, strut grafts, or plates for fracture fixation.

Different options are available based on surgeon's preference and classification of periprosthetic fractures:

• Diaphyseal fixation with long cylindrical porous coated stem

• Diaphyseal fixation with long tapered stem

• Compression plate and screw + cerclage

Routine physiotherapy protocols for elective total hip arthroplasty is followed.

Early mobilization is recommended. Weight bearing status is individualized based upon fixation and implant stability.

Hip dislocation precautions are given to the patient.

Postoperative radiographs can be made at 2 to 3 weeks to determine maintenance of satisfactory fracture reduction and fixation, no evidence of stem subsidence, or fracture displacement.

Follow-up radiographs can be made at 6 to 8 weeks after surgery to determine sufficient fracture fixation to increase the weight bearing status, and physical activities.

Future follow-up is similar to the routine and standard protocol for total hip arthroplasty.