Increasing numbers of
total hip arthroplasties in combination with increasing age and growing daily activities of the elderly lead to increasing numbers of
periprosthetic fractures and revision
arthroplasties in osteoporotic bone. The
prosthesis nail is a hybrid of a
hip prosthesis and an intramedullary nail allowing immediate full weight bearing and early rehabilitation. The
prosthesis nail consists of three self-locking components: a distally locked intramedullary nail, different lengthening modules, and a
hip prosthesis module. From 1992 to 1999, 28
prosthesis nails were implanted in 26 patients (40-88 years, mean age: 71 years). The indications were 21 peri- and subprosthetic fractures caused by
trauma, 2 fractures of the proximal femur in combination with a fracture of the femoral head or severe
degenerative arthritis, and 4 revision
arthroplasties associated with poor bone quality. A combination of the
prosthesis nail and
bone cement was used in one patient suffering from a
pathological fracture of the distal femur. Patients were additionally treated with wire cerclage (six patients) and autogenous
bone grafting (ten patients). All patients-except those who received a reconstruction of the acetabulum in the same session (four patients)-were mobilized with full weight bearing on the operated side as soon as
wound pain diminished. Bone healing was observed in all
periprosthetic fractures. In three patients the
prosthesis nail had to be revised: one patient suffered from recurrent dislocations and in one patient weighing 350 pounds limb shortening occurred after the distal locking screw broke. Intramedullary
infection was observed once
after treatment of a
periprosthetic fracture. When bone union was achieved the
prosthesis nail was removed and the patient was mobilized with a girdlestone situation. The idea of the
prosthesis nail is based on the logical consequence of treating femur fractures with the most efficient procedure, which is
intramedullary nailing. The
prosthesis nail can be applied according to the requirements of the fracture as a reamed or unreamed nail and immediate full weight bearing is possible. Considering the high average age of the patients, low morbidity, short rehabilitation time, and low costs are the major advantages of this new device. Taking into account the unfavorable preoperative conditions associated with elderly and multimorbid patients, the rate of complications is relatively low.