Early results of the LPS™ limb preservation system in the management of periprosthetic femoral fractures.

INTRODUCTION: Achieving skeletal fixation in the presence of progressive bone loss is a surgical challenge, especially in cases of periprosthetic fracture (PPF). Unpredictable fracture patterns and preexisting bone loss frequently combine in this patient group. Megaprosthetic arthroplasty allows for immediate mobilisation and shorter periods of rehabilitation. We describe the clinical outcomes of a cohort of LPS™ megaprostheses performed for PPF by a single surgeon at our institution.

METHODS: Between July 2013 and November 2015, 23 patients underwent endoprosthetic femoral replacement of which 16 were performed for PPF or bone loss. Patient demographics, surgical indication, operative details, implant composition, blood loss, survival, and revision surgery details were recorded in a prospectively maintained database. Patients underwent serial clinical and X-ray evaluations at 6 weeks, 3 months and 6 months post surgery with yearly reviews thereafter.

RESULTS: The PPF cohort consisted of 9 males and 7 females with a mean age of 75 and a mean follow up of 19.2 months. The mean Oxford score prior to fracture was 41 (range 12-48), and 39 (range 13-48, p  = 0.6) post megaprosthesis insertion. Postoperative dislocation of the megaprosthesis occurred in two patients (12.5%), with no postoperative infections recorded.

CONCLUSION: We report minimal postoperative changes in functional outcome scores. The results of revision arthroplasty with LPS™ proximal femur megaprosthesis were satisfactory in 15/16 patients at a mean follow-up of 19.2 months. We recommend the use of megaprostheses in patients with markedly deficient bone stock for whom other available reconstructive procedures are unavailable.