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Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2020

Open Access 01-12-2020 | Femoral Fracture | Research article

Periprosthetic proximal femoral fractures in cemented and uncemented stems according to Vancouver classification: observation of a new fracture pattern

Authors: James Karam, Paul Campbell, Shivang Desai, Michael Hunter

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2020

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Abstract

Background

Periprosthetic fractures are increasingly encountered in hip arthroplasty. The Vancouver classification system is widely used. Little knowledge exists regarding the association of the Vancouver classification with either cemented or uncemented stems. The aim was to analyse a series of fractures and determine associations.

Methods

A series of consecutive patients over 8 years was identified including only post-operative fractures of primary hip arthroplasties. Baseline and radiographic characteristics were recorded including the type of stem fixation (cemented or uncemented) and Vancouver classification. Statistical analysis was performed to determine the association of the Vancouver classification between cemented and uncemented stems.

Results

A total of 172 patients were identified (84 cemented stems, 88 uncemented stems). There were 30 Vancouver A fractures (12 cemented vs.18 uncemented, p > 0.05), 125 Vancouver B fractures (63 cemented vs. 62 uncemented, p > 0.05) and 17 Vancouver C fractures (9 cemented vs. 8 uncemented, p > 0.05). The Vancouver B2 fracture occurred most frequently (N = 95; 44 cemented vs. 51 uncemented, p > 0.05) and consists of four distinct fracture patterns: the previously described comminuted ‘burst’, clamshell and spiral patterns and the newly observed ‘reverse’ clamshell. The burst and spiral fracture patterns are significantly associated with cemented stems, and the clamshell pattern is significantly associated with uncemented stems.

Conclusions

Vancouver A, B and C fractures occur equally in cemented and uncemented stems. Awareness of four distinct Vancouver B2 fracture patterns, including the newly observed reverse clamshell, will aid surgeons in predicting stem instability.
Literature
1.
Abdel M, Watts C, Houdek M, Lewallen D, Berry D. Epidemiology of periprosthetic fracture of the femur in 32,644 primary total hip arthroplasties. Bone Joint J. 2016;98-B:461–7.CrossRefPubMed
2.
Pivec R, Issa K, Kapadia B, Charian J, Maheshwari A, Bonutti P, et al. Incidence and future projections of periprosthetic femoral fracture following total hip arthroplasty: an analysis of international registry data. J Long Term Eff Med Implants. 2015;25:269–75.CrossRefPubMed
3.
Lindberg-Larsen M, Jorgensen C, Solgaard S, Kjersgaard A, Kehlet H. Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems. Acta Orthop. 2017;88(4):390–4.CrossRefPubMedPubMedCentral
4.
Song J, Dillman D, Wilson D, Dunbar M, Richardson G. Higher periprosthetic fracture rate associated with use of modern uncemented stems compared to cemented stems in femoral neck fractures. HIP International. 2019;29(2):177–83.CrossRefPubMed
5.
Chatziagorou G, Lindahl H, Garellick G, Karrholm J. Incidence and demographics of 1751 surgically treated periprosthetic femoral fractures around a primary hip prosthesis. HIP Int. 2019;29(3):282–8.CrossRefPubMed
6.
Thien T, Chatziagorou G, Garellick G, Furnes O, Havelin L, Makela K, et al. Periprosthetic femoral fracture within two years after total hip replacement. J Bone Joint Surg Am. 2014;96(1-7):167.CrossRef
7.
Duncan C, Masri B. Fractures of the femur after hip replacement. Inst Course Lect. 1995;44:293–304.
8.
Brady O, Garbuz D, Masri B, Duncan C. The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty. 2000;15(1):59–62.CrossRefPubMed
9.
Rayan F, Dodd M, Haddad F. European validation of the Vancouver classification of peri-prosthetic proximal femoral fractures. Bone Joint J. 2008;90-B:1576–9.
10.
Naqvi G, Baig S, Awan N. Interobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty. J Arthroplasty. 2012;27(6):1047–50.CrossRefPubMed
11.
Fenelon C, Murphy E, Baig M, Kearns S, Murphy C, Curtin W. Breaking bad: a comparative descriptive analysis of periprosthetic fractures around cemented and uncemented femoral stems. J Arthroplasty. 2019; (Epub ahead of print).
12.
Lindahl H, Garellick G, Regner H, Herberts P, Malchau H. Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am. 2006;88-A(6):1215–22.CrossRef
13.
Fleischman A, Chen A. Management of Vancouver B2 peri-prosthetic femoral fracture: following the evidence. Ann Joint. 2016;15:168.
14.
Broden C, Mukka S, Muren O, Eisler T, Boden H, Stark A, et al. High risk of early periprosthetic fractures after primary hip arthroplasty in elderly patients using a cemented, tapered, polished stem. Acta Orthop. 2015;86(2):169–74.CrossRefPubMedPubMedCentral
15.
Phillips J, Boulton C, Moran C, Manktelow A. Periprosthetic fractures around Exeter stems: a new injury? Bone Joint J. 2012;94-B(Suppl. XXV):187.
16.
Quah C, Porteous M, Stephen A. Principles of managing Vancouver type B periprosthetic fractures around cemented polished tapered femoral stems. Eur J Orthop Surg Traumatol. 2017;27:477–82.CrossRefPubMed
17.
Capello W, D’Antonio J, Naughton M. Periprosthetic fractures around a cementless hydroxyapatite-coated implant. Clin Orthop Relat Res. 2014;472:604–10.CrossRefPubMed
18.
Cottino U, Dettoni F, Caputo G, Bonasia D, Rossi P, Rossi R. Incidence and pattern of periprosthetic hip fractures around the stem in different stem geometry. Int Orthopaedics. 2019; (Epub ahead of print).
19.
Carli A, Negus J, Haddad F. Periprosthetic femoral fractures and trying to avoid them. Bone Joint J. 2017;99-B(1 Supple A):50–9.CrossRefPubMed
20.
Grammatopoulous G, Pandit H, Kambouroglou G, Deakin M, Gundle R, Mclardy-Smith P, et al. A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement. Injury. 2011;42:1271–6.CrossRef
21.
Erhardt J, Khoo P, Stoffel K, Yates P. Periprosthetic fractures around polished collarless cemented stems: the effect of stem design on fracture pattern. Hip Int. 2013;23(5):459–64.CrossRefPubMed
22.
Rupp M, Kern S, Ismat A, El Khassawna T, Knapp G, Szalay G, et al. Computed tomography for managing periprosthetic femoral fractures. A retrospective analysis. BMC Musculoskelet Disord. 2019;20:258.CrossRefPubMedPubMedCentral
23.
Khan T, Grindlay D, Ollivere B, Scammell B, Manktelow A, Pearson R. A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Joint J. 2017;(4 Supple. B):17–25.
24.
Gaski G, Scully S. Classifications in brief: Vancouver classification of postoperative periprosthetic femur fracture. Clin Orthop Relat Res. 2011;469:1507–10.CrossRefPubMed
25.
Smitham P, Carbone T, Bolam S, Kim Y, Callary S, Costi K, et al. Vancouver B2 peri-prosthetic fractures in cemented femoral implants can be treated with open reduction and internal fixation alone without revision. J Arthroplasty. 2019;34:1430–4.CrossRefPubMed
26.
Spina M, Scalvi A. Vancouver B2 periprosthetic femoral fractures: a comparative study of stem revision versus internal fixation with plate. Eur J Orthop Surg Traumatol. 2018;28:1133–42.CrossRefPubMed
27.
Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, knee and shoulder arthroplasty: 2018 Annual Report. Adelaide: AOA; 2018.
28.
Peitgen D, Innmann M, Merle C, Gotterbarm T, Moradi B, Streit M. Cumulative long-term incidence of postoperative periprosthetic femoral fractures using an uncemented tapered titanium hip stem: 26 to 32-year results. J Arthroplasty. 2019;34:77–81.CrossRefPubMed
29.
Gromov K, Bersang A, Nielsen C, Kallemose T, Husted H, Troelsen A. Risk factors for post-operative periprosthetic fractures following primary total hip arthroplasty with a proximally coated double-tapered cementless femoral implant. Bone Joint J. 2017;(99-B:4):451–7.
30.
Hossain M, Thomas G, Beard D, Murray D, Andrew G. The consequences of varus implantation of a taper-slip cemented femoral stem. Bone Joint J. 2010;94-B(Suppl. XXI):187.
Metadata
Title
Periprosthetic proximal femoral fractures in cemented and uncemented stems according to Vancouver classification: observation of a new fracture pattern
Authors
James Karam
Paul Campbell
Shivang Desai
Michael Hunter
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2020
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-020-01619-4

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