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European Journal of Orthopaedic Surgery & Traumatology

02-05-2024 | Periprosthetic Fracture | Original Article

Cemented vs cementless stems for revision arthroplasties due to Vancouver B2 periprosthetic hip fracture

Authors: Yuri Lara-Taranchenko, Josep F. Nomdedéu Jr., Andrés Aliaga Martínez, Iñaki Mimendia, Víctor M. Barro, Diego Collado, Ernesto Guerra-Farfán, Alejandro Hernández

Published in: European Journal of Orthopaedic Surgery & Traumatology

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Abstract

Purpose

According to Vancouver classification, B2 type fractures are most often treated with removal of the loose stem and implantation of a long stem that bypasses the fracture site. However, there is a controversy about the stem fixation that should be used: cemented or cementless. Hence, this study aims to compare cemented and cementless stems in prosthetic revision due to Vancouver B2 (VB2) periprosthetic hip fracture.

Methods

A retrospective study was done including all the patients treated with stem exchange due to VB2 periprosthetic hip fracture in a tertiary hospital between 2015 and 2022. Patients were divided into two groups according to the stem fixation used: cemented or cementless. Functional outcomes, hospital stay, surgical time, complication rate, and mortality were compared between the two groups of patients.

Results

Of the 30 included patients, 13 (43.4%) were treated with cementless stems and 17 (56.7%) with cemented stems. There were no statistically significant differences in age, gender, anesthesia risk scale (ASA) or functional capacity prior to the intervention. Patients treated with cementless stems had a higher complication and reintervention rate than those treated with cemented stems: 62 and 45% versus 34 and 6% (p = 0.035; p = 0.010), respectively. Furthermore, in the group of cementless stems a higher proportion of non-union was found (53.8% vs. 17.6%; p = 0.037). Also, the hospital stay (33 vs. 24 days; p = 0.037) and the time to full weight-bearing (21 days vs. 9 days; p < 0.001) were longer in the cementless stem group.

Conclusion

Cemented fixation in stem revision due to Vancouver B2 periprosthetic hip fracture could be an optimal option with faster recovery which could decrease the rate of complications and reintervention, without compromising the fracture healing and patient mortality. Thus, this option can be considered when an anatomical reduction can be obtained, especially in elderly patients with multiple comorbidities in which a less aggressive surgical option should be considered.
Literature
1.
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
2.
Shah RP, Sheth NP, Gray C, Alosh H, Garino JP (2014) Periprosthetic fractures around loose femoral components. J Am Acad Orthop Surg 22(8):482–490CrossRefPubMed
3.
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
4.
Marsland D, Mears SC (2012) A review of periprosthetic femoral fractures associated with total hip arthroplasty. Geriatr Orthop Surg Rehabil 3(3):107–120CrossRefPubMedPubMedCentral
5.
Duncan CP, Haddad FS (2014) The unified classification system (UCS): improving our understanding of periprosthetic fractures. Bone Jt J 96-B(6):713–716CrossRef
6.
Lee S, Kagan R, Wang L, Doung YC (2019) Reliability and validity of the Vancouver classification in periprosthetic fractures around cementless femoral stems. J Arthroplasty 34:S277–S281CrossRefPubMed
7.
Khan T, Grindlay D, Ollivere BJ, Scammell BE, Manktelow ARJ, Pearson RG (2017) A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Jt J 99-B(4 Supple B):17–25CrossRef
8.
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 Orthop Traumatol 28(6):1133–1142CrossRef
9.
Smitham PJ, Carbone TA, Bolam SM, Kim YS, Callary SA, Costi K et al (2019) Vancouver B2 peri-prosthetic fractures in cemented femoral implants can be treated with open reduction and internal fixation alone without revision. J Arthroplasty 34(7):1430–1434CrossRefPubMed
10.
Tyson Y, Hillman C, Majenburg N, Sköldenberg O, Rolfson O, Kärrholm J et al (2021) Uncemented or cemented stems in first-time revision total hip replacement? An observational study of 867 patients including assessment of femoral bone defect size. Acta Orthop 92(2):143–150CrossRefPubMed
11.
Klasan A, Millar J, Quayle J, Farrington B, Misur PN (2022) Comparable outcomes of in-cement revision and uncemented modular stem revision for Vancouver B2 periprosthetic femoral fracture at 5 years. Arch Orthop Trauma Surg 142(6):1039–1046CrossRefPubMed
12.
Canbora K, Kose O, Polat A, Aykanat F, Gorgec M (2013) Management of Vancouver type B2 and B3 femoral periprosthetic fractures using an uncemented extensively porous-coated long femoral stem prosthesis. Eur J Orthop Surg Traumatol Orthop Traumatol 23(5):545–552CrossRef
13.
Briant-Evans T, Veeramootoo D, Tsiridis E, Hubble M (2009) Cement-in-cement stem revision for Vancouver type B periprosthetic femoral fractures after total hip arthroplasty. Acta Orthop 80:548–552CrossRefPubMedPubMedCentral
14.
Emara AK, Ng M, Krebs VE, Bloomfield M, Molloy RM, Piuzzi NS (2021) Femoral stem cementation in hip arthroplasty: the know-how of a ‘“lost”’ art. Curr Rev Musculoskelet Med 14(1):47–59CrossRefPubMedPubMedCentral
15.
Abdulkarim A, Ellanti P, Motterlini N, Fahey T, O’Byrne J (2013) Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials. Orthop Rev 5(1):34–44
16.
Tyson Y, Rolfson O, Kärrholm J, Hailer NP, Mohaddes M (2019) Uncemented or cemented revision stems? Analysis of 2296 first-time hip revision arthroplasties performed due to aseptic loosening, reported to the Swedish hip arthroplasty register. Acta Orthop 90(5):421–426CrossRefPubMedPubMedCentral
17.
Roussot MA, Vles GF, Haddad FS (2018) The role of cemented stems in revision total hip arthroplasty. Sem Arthroplast 29(3):177–182CrossRef
18.
Sponer P, Korbel M, Grinac M, Prokes L, Bezrouk A, Kucera T (2021) The outcomes of cemented femoral revisions for periprosthetic femoral fractures in the elderly: comparison with cementless stems. Clin Interv Aging 16:1869–1876CrossRefPubMedPubMedCentral
19.
Brew CJ, Wilson LJ, Whitehouse SL, Hubble MJW, Crawford RW (2013) Cement-in-cement revision for selected Vancouver type B1 femoral periprosthetic fractures: a biomechanical analysis. J Arthroplasty 28(3):521–525CrossRefPubMed
Metadata
Title
Cemented vs cementless stems for revision arthroplasties due to Vancouver B2 periprosthetic hip fracture
Authors
Yuri Lara-Taranchenko
Josep F. Nomdedéu Jr.
Andrés Aliaga Martínez
Iñaki Mimendia
Víctor M. Barro
Diego Collado
Ernesto Guerra-Farfán
Alejandro Hernández
Publication date
02-05-2024
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-024-03961-3