Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Orthopaedics

Open Access 23-04-2024 | Femoral Fracture | Original Paper

Long stem revision versus short stem revision with plate osteosynthesis for Vancouver type B2 periprosthetic femoral fracture: a comparative study of eighty five cases

Authors: Jian-Jiun Chen, Shih-Hsin Hung, Jia-You Liou, Wen-Chieh Chang, Kuei-Hsiang Hsu, Yu-Pin Su, Fang-Yao Chiu, Ming-Fai Cheng

Published in: International Orthopaedics

Login to get access

Abstract

Purpose

Periprosthetic femoral fractures (PPFs) around the hip are challenging complications in orthopaedic surgery, particularly Vancouver type B2 (VTB2) fractures. The surgical management of these fractures is crucial and depends on various factors. Cementless short taper stem with plate osteosynthesis is an alternative surgical technique. This study aims to compare the outcomes of this surgical technique with revision arthroplasty (RA) with long stem in the treatment of VTB2 PPFs.

Methods

This retrospective study was conducted in a single medical institute from February 2010 to May 2019. Patients who had received either total hip arthroplasty or bipolar hemiarthroplasty and subsequently developed a VTB2 PPF were included; patients who sustained intra-operative fractures or received a cemented stem previously were excluded from the analysis. The patients were divided into two groups: group I received RA with cementless long stem, while group II underwent RA with cementless short taper stem with plate osteosynthesis. Demographic data, radiographic and functional outcomes, and complications were analyzed between the two groups.

Results

A total of 85 patients diagnosed with VTB2 PPFs were included in the study. There were no significant differences between the two groups in terms of demographic data, including age, gender, mean follow-up times, estimated blood loss, and operative times. The radiographic results showed that there was no significant difference in the incidence of subsidence and implant stability between the two groups. However, group II tended to have less subsidence and periprosthetic osteolysis. Patients in group II had significantly better functional scores (mean Harris hip score: post-operative: 60.2 in group I and 66.7 in group ii; last follow-up: 77.4 in group 1 and 83.2 in group II (both p < 0.05)). There were no significant differences in the overall complication rate, including infection, dislocation, re-fracture, and revision surgery, between the two groups.

Conclusions

Both surgical techniques, cementless long stem and cementless short taper stem with plate osteosynthesis, are effective in the treatment of Vancouver B2 PPFs, with no significant differences in outcomes or complications. However, patients in cementless short taper stem with plate osteosynthesis had better functional scores at both post-operative and the last follow-up.
Literature
1.
Abdel MP, Cottino U, Mabry TM (2015) Management of periprosthetic femoral fractures following total hip arthroplasty: a review. Int Orthop 39(10):2005–2010CrossRefPubMed
2.
Baum C, Leimbacher M, Kriechling P, Platz A, Cadosch D (2019) Treatment of periprosthetic femoral fractures Vancouver type B2: revision arthroplasty versus open reduction and internal fixation with locking compression plate. Geriatr Orthop Surg Rehabil 10:2151459319876859CrossRefPubMedPubMedCentral
3.
Blakeney WG, Lavigne M, Beaulieu Y, Puliero B, Vendittoli PA (2021) Mid-term results of total hip arthroplasty using a novel uncemented short femoral stem with metaphyso-diaphyseal fixation. Hip Int 31(1):83–89CrossRefPubMed
4.
Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ (2009) The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 91(1):128–133CrossRefPubMed
5.
Chatziagorou G, Lindahl H, Kärrholm J (2019) Surgical treatment of Vancouver type B periprosthetic femoral fractures. Bone Joint Journal 101-B(11):1447–1458PubMed
6.
Dargan D, Jenkinson MJ, Acton JD (2014) A retrospective review of the Dall-Miles plate for periprosthetic femoral fractures: twenty-seven cases and a review of the literature. Injury 45(12):1958–1963CrossRefPubMed
7.
Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304PubMed
8.
Frenzel S, Vécsei V, Negrin L (2015) Periprosthetic femoral fractures–incidence, classification problems and the proposal of a modified classification scheme. Int Orthop 39(10):1909–1920CrossRefPubMed
9.
González-Martín D, Pais-Brito JL, González-Casamayor S, Guerra-Ferraz A, Ojeda-Jiménez J, Herrera-Pérez M (2022) Treatment algorithm in Vancouver B2 periprosthetic hip fractures: osteosynthesis vs revision arthroplasty. EFORT Open Rev 7(8):533–541CrossRefPubMedPubMedCentral
10.
11.
Innocenti M, Smulders K, Andreotti M, Willems JH, Van Hellemondt G, Nijhof MW (2023) The use of a standard-length conical tapered stem in hip revision arthroplasty to address Paprosky type I-II femoral defects: a prospective study of 87 patients. Arch Orthop Trauma Surg 143(9):5945–5955CrossRefPubMedPubMedCentral
12.
Joestl J, Hofbauer M, Lang N, Tiefenboeck T, Hajdu S (2016) Locking compression plate versus revision-prosthesis for Vancouver type B2 periprosthetic femoral fractures after total hip arthroplasty. Injury 47(4):939–943CrossRefPubMed
13.
Khuangsirikul S, Chotanaphuti T (2020) Management of femoral bone loss in revision total hip arthroplasty. J Clin Orthop Trauma 11(1):29–32CrossRefPubMed
14.
Kinov P, Volpin G, Sevi R, Tanchev PP, Antonov B, Hakim G (2015) Surgical treatment of periprosthetic femoral fractures following hip arthroplasty: our institutional experience. Injury 46(10):1945–1950CrossRefPubMed
15.
Lenz M, Stoffel K, Kielstein H, Mayo K, Hofmann GO, Gueorguiev B (2016) Plate fixation in periprosthetic femur fractures Vancouver type B1-Trochanteric hook plate or subtrochanterical bicortical locking? Injury 47(12):2800–2804CrossRefPubMed
16.
Lewis DP, Tarrant SM, Cornford L, Balogh ZJ (2022) Management of Vancouver B2 periprosthetic femoral fractures, revision total hip arthroplasty versus open reduction and internal fixation: a systematic review and meta-analysis. J Orthop Trauma 36(1):7–16CrossRefPubMed
17.
Li D, Hu Q, Kang P et al (2018) Reconstructed the bone stock after femoral bone loss in Vancouver B3 periprosthetic femoral fractures using cortical strut allograft and impacted cancellous allograft. Int Orthop 42(12):2787–2795CrossRefPubMed
18.
Lindahl H (2007) Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury 38(6):651–654CrossRefPubMed
19.
Lindahl H, Malchau H, Herberts P, Garellick G (2005) Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 20(7):857–865CrossRefPubMed
20.
Lochab J, Carrothers A, Wong E et al (2017) Do transcortical screws in a locking plate construct improve the stiffness in the fixation of Vancouver B1 periprosthetic femur fractures? A biomechanical analysis of 2 different plating constructs. J Orthop Trauma 31(1):15–20CrossRefPubMed
21.
Martinov S, D’Ulisse S, Haumont E, Schiopu D, Reynders P, Illés T (2022) Comparative study of Vancouver type B2 periprosthetic fractures treated by internal fixation versus stem revision. Arch Orthop Trauma Surg 142(12):3589–3597CrossRefPubMed
22.
Masri BA, Meek RM, Duncan CP (2004) Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 420:80–95CrossRef
23.
Park JS, Hong S, Nho JH, Kang D, Choi HS, Suh YS (2019) Radiologic outcomes of open reduction and internal fixation for cementless stems in Vancouver B2 periprosthetic fractures. Acta Orthop Traumatol Turc 53(1):24–29CrossRefPubMed
24.
Patsiogiannis N, Kanakaris NK, Giannoudis PV (2021) Periprosthetic hip fractures: an update into their management and clinical outcomes. EFORT Open Rev 6(1):75–92CrossRefPubMedPubMedCentral
25.
26.
Solomon LB, Hussenbocus SM, Carbone TA, Callary SA, Howie DW (2015) Is internal fixation alone advantageous in selected B2 periprosthetic fractures? ANZ J Surg 85(3):169–173CrossRefPubMed
27.
Spina M, Scalvi A (2018) Vancouver B2 periprosthetic femoral fractures: a comparative study of stem revision versus internal fixation with plate. Eur J Orthop Surg Traumatol 28(6):1133–1142CrossRefPubMed
28.
Stoffel K, Blauth M, Joeris A, Blumenthal A, Rometsch E (2020) Fracture fixation versus revision arthroplasty in Vancouver type B2 and B3 periprosthetic femoral fractures: a systematic review. Arch Orthop Trauma Surg 140(10):1381–1394CrossRefPubMedPubMedCentral
29.
Thien TM, Chatziagorou G, Garellick G et al (2014) Periprosthetic femoral fracture within two years after total hip replacement: analysis of 437,629 operations in the nordic arthroplasty register association database. J Bone Joint Surg Am 96(19):e167CrossRefPubMed
30.
Thomsen PB, Jensen NJ, Kampmann J, Bæk Hansen T (2013) Revision hip arthroplasty with an extensively porous-coated stem - excellent long-term results also in severe femoral bone stock loss. Hip Int 23(4):352–358CrossRefPubMed
31.
Ulusoy İ, Yılmaz M, Kıvrak A (2023) Efficacy of autologous stem cell therapy in femoral head avascular necrosis: a comparative study. J Orthop Surg Res 18(1):799CrossRefPubMedPubMedCentral
32.
van Oldenrijk J, Molleman J, Klaver M, Poolman RW, Haverkamp D (2014) Revision rate after short-stem total hip arthroplasty: a systematic review of 49 studies. Acta Orthop 85(3):250–258CrossRefPubMedPubMedCentral
33.
Zheng H, Gu H, Shao H et al (2020) Treatment and outcomes of Vancouver type B periprosthetic femoral fractures. Bone Joint J 102-B(3):293–300CrossRefPubMed
Metadata
Title
Long stem revision versus short stem revision with plate osteosynthesis for Vancouver type B2 periprosthetic femoral fracture: a comparative study of eighty five cases
Authors
Jian-Jiun Chen
Shih-Hsin Hung
Jia-You Liou
Wen-Chieh Chang
Kuei-Hsiang Hsu
Yu-Pin Su
Fang-Yao Chiu
Ming-Fai Cheng
Publication date
23-04-2024
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-024-06181-w