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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 11/2022

Open Access 14-08-2021 | Femoral Fracture | Trauma Surgery

Vancouver B and C periprosthetic fractures around the cemented Exeter Stem: sex is associate with fracture pattern

Authors: M. F. R. Powell-Bowns, E. Oag, D. Martin, N. D. Clement, C. E. H. Scott

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 11/2022

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Abstract

Introduction

The aim of this study was to identify factors associated with the level of periprosthetic fracture involving a cemented polished tapered stem: Vancouver B or Vancouver C.

Methods

A retrospective cohort study of 181 unilateral periprosthetic fractures involving Exeter stems was assessed by three observers (mean age 78.5, range 39–103; mean BMI 27.1, 17–39; 97 (54%) male). Patient demographics, deprivation scores, BMI and time since primary prosthesis were recorded. Femoral diameter, femoral cortical thickness, Dorr classification and distal cement mantle length were measured from calibrated radiographs. Interobserver reliability was calculated using intraclass correlation coefficients (ICCs). Univariate and multivariate analysis was performed to identify associations with Vancouver B or C fractures.

Results

160/181 (88%) Vancouver B and 21/181 (12%) Vancouver C-level fractures occurred at a mean of 5.9 ± 5.4 years (0.2–26.5) following primary surgery. Radiographic measurements demonstrated excellent agreement (ICC > 0.8, p < 0.001). Mortality was significantly higher following Vancouver C compared to B fractures: 90 day 14/160 Vs 5/21 (p = 0.05); 1 year 29/160 Vs 8/21 (p = 0.03). Univariate analysis demonstrated that Vancouver C fractures were associated with female sex, bisphosphonate use, cortical bone thickness, and distal cement mantle length (p < 0.05). On multivariate analysis, only female sex was an independent predictor of Vancouver C-level fractures (R2 =0.354, p = 0.005).

Conclusion

Most PFFs involving the Exeter stem design are Vancouver B-type fractures and appear to be independent of osteoporosis. In contrast, Vancouver C periprosthetic fractures display typical fragility fracture characteristics and are associated with female sex, thinner femoral cortices, longer distal cement mantles and high mortality.
Literature
1.
Abdel MP et al (2016) Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Jt J 98-B(4):461–467 CrossRef
2.
3.
Palan J et al (2016) The influence of cemented femoral stem choice on the incidence of revision for periprosthetic fracture after primary total hip arthroplasty: an analysis of national joint registry data. Bone Jt J 98-B(10):1347–1354 CrossRef
4.
Chatziagorou G, Lindahl H, Kärrholm J (2019) The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems. Acta Orthop 90(2):135–142 CrossRef
5.
Lamb JN et al (2019) A calcar collar is protective against early periprosthetic femoral fracture around cementless femoral components in primary total hip arthroplasty: a registry study with biomechanical validation. Bone Jt J 101-B(7):779–786 CrossRef
6.
7.
8.
Scheerlinck T, Casteleyn PP (2006) The design features of cemented femoral hip implants. J Bone Jt Surg Br 88(11):1409–1418 CrossRef
9.
Lindahl H et al (2006) Three hundred and twenty-one periprosthetic femoral fractures. J Bone Jt Surg Am 88(6):1215–1222 CrossRef
10.
Petheram TG et al (2016) The Exeter Universal cemented femoral stem at 20 to 25 years: a report of 382 hips. Bone Jt J 98-B(11):1441–1449 CrossRef
11.
Mukka S et al (2016) Substantially higher prevalence of postoperative peri-prosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem. Acta Orthop 87(3):257–261 CrossRef
12.
Singh JA et al (2013) Are gender, comorbidity, and obesity risk factors for postoperative periprosthetic fractures after primary total hip arthroplasty? J Arthroplasty 28(1):126-131.e2 CrossRef
13.
Jain S et al (2021). Risk factors influencing fracture characteristics in postoperative periprosthetic femoral fractures around cemented stems in total hip arthroplasty : a multicentre observational cohort study on 584 fractures. Bone Jt Open 2(7):466–475 CrossRef
14.
Brady OH et al (1999) Classification of the hip. Orthop Clin North Am 30(2):215–220 CrossRef
15.
Lee S et al (2019) Reliability and validity of the vancouver classification in periprosthetic fractures around cementless femoral stems. J Arthroplasty 34(7S):S277–S281 CrossRef
16.
Khan T et al (2017) A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Jt J 99-B(4 Supple B):17–25 CrossRef
17.
Lindahl H et al (2005) Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 20(7):857–865 CrossRef
18.
Scottish_Government (2016) The Scottish government Scottish index of multiple deprivation. Scottish Index of Multiple Deprivation 2016: introductory booklet - gov.scot (www.gov.scot). [cited 2016 02/11/2016]
19.
Dorr LD et al (1993) Structural and cellular assessment of bone quality of proximal femur. Bone 14(3):231–242 CrossRef
20.
Capone A et al (2017) Periprosthetic fractures: epidemiology and current treatment. Clin Cases Miner Bone Metab 14(2):189–196 CrossRef
21.
Gitajn IL et al (2017) Mortality following surgical management of vancouver B periprosthetic fractures. J Orthop Trauma 31(1):9–14 CrossRef
22.
Powell-Bowns MFR et al (2021) Vancouver B periprosthetic fractures involving the Exeter cemented stem; reducible fractures with intact bone-cement interfaces can be fixed. Bone Jt J 103-B(2):303–320 CrossRef
23.
Giummarra MJ et al (2020) Twelve month mortality rates and independent living in people aged 65 years or older after isolated hip fracture: a prospective registry-based study. Injury 51(2):420–428 CrossRef
24.
25.
26.
27.
Grammatopoulos G et al (2011) A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement. Inj 42(11):1271–1276.
28.
Callister WD, Rethwisch DG (2011) Materials science and engineering. 8th edn. John Wiley and Sons, Inc., Asia
29.
Gunn E, Gundapaneni D, Goswami T (2012) Effect of cement fill ratio in loosening of hip implants. Boimatter 2(2):87–93
30.
Katzer A, Morlock M (2007) Cement mantle defects in total hip arthroplasty: influence of stem size and cemeneting technique. J Orthop Traumatol 8(4):167–172
31.
Nash W, Harris A (2014) The Dorr type and cortical thickness index of the proximal femur for predicting perioperative complications during hemiarthroplasty. J Orthpaedic Surg 22(1):92–99
Metadata
Title
Vancouver B and C periprosthetic fractures around the cemented Exeter Stem: sex is associate with fracture pattern
Authors
M. F. R. Powell-Bowns
E. Oag
D. Martin
N. D. Clement
C. E. H. Scott
Publication date
14-08-2021
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 11/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-021-04113-6

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