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

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2023

Open Access 01-12-2023 | Periprosthetic Fracture | Research

Outcomes of fixation of Vancouver B periprosthetic fractures around cemented versus uncemented stems

Authors: Ameen Barghi, Philip Hanna, Nelson Merchan, Michael J. Weaver, John Wixted, Paul Appleton, Edward Rodriguez

Published in: BMC Musculoskeletal Disorders | Issue 1/2023

Login to get access

Abstract

Background

The incidence of periprosthetic femur fracture (PPFF) in the setting of total hip arthroplasty (THA) is steadily increasing. We seek to address whether there is a difference in outcomes between Vancouver B fracture types managed with ORIF when the original stem was a press-fit stem versus a cemented stem.

Methods

In this retrospective cohort study at a level 1 trauma center, we identified 136 patients over 65 years-of-age with Vancouver B-type fractures sustained between 2005 and 2019. Patients were treated by ORIF and had either cemented or press-fit stems prior to their injury. Outcomes were subsidence of the femoral implant, time to full weight bearing, rate of the hip implant revision, estimated blood loss (EBL), postoperative complications, and the one-year mortality rate.

Results

A total of 103 (75.7%) press-fit and 33 (24.3%) cemented patients were reviewed. Patient baseline characteristics, Vancouver fracture sub-types, and implant characteristics were not found to be significantly different between groups. The difference in subsidence rates, postoperative complications, and time to weight bearing were not significantly different between groups. EBL and one-year mortality rate were significantly higher in the cemented group.

Conclusions

In geriatric patients with Vancouver B type periprosthetic fractures managed with ORIF, patients with an originally press fit stem may have lower mortality, lower estimated blood loss, and similar subsidence and hospital length of stays when compared to those with a cemented stem.
Literature
1.
Lindahl H, Garellick G, Regnér H, Herberts P, Malchau H. Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am. 2006;88:1215–22.PubMedCrossRef
2.
Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007;38:651–4.PubMedCrossRef
3.
Della Rocca GJ, Leung KS, Pape H-C. Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma. 2011;25:S66–70.PubMedCrossRef
4.
Brady OH, Garbuz DS, Masri BA, Duncan CP. The reliability of validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty. 2000;15:59–62.PubMedCrossRef
5.
Rayan F, Dodd M, Haddad F. European validation of the Vancouver classification of periprosthetic proximal femoral fractures. J Bone Joint Surg Br. 2008;90:1576–9.PubMedCrossRef
6.
Lee S-R, Bostrom M. Periprosthetic fractures of the femur after total hip arthroplasty. Instr Course Lect. 2004;53:111–8.PubMed
7.
Drew JM, Griffin WL, Odum SM, Van Doren B, Weston BT, Stryker LS. Survivorship after periprosthetic femur fracture: factors affecting outcome. J Arthroplasty. 2016;31:1283–8.PubMedCrossRef
8.
Khan T, Grindlay D, Ollivere B, Scammell B, Manktelow A, Pearson RG. A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Joint J. 2017;99:17–25.PubMedCrossRef
9.
Barghi A, Hanna P, Merchan N, et al. Outcomes after operative fixation of Vancouver B2 and B3 type periprosthetic fractures. J Orthop Trauma. 2022;36:228–33.PubMedCrossRef
10.
Gitajn IL, Heng M, Weaver MJ, et al. Mortality following surgical management of Vancouver B periprosthetic fractures. J Orthop Trauma. 2017;31:9–14.PubMedCrossRef
11.
Haider T, Hanna P, Mohamadi A, et al. Revision arthroplasty versus open reduction and internal fixation of vancouver type-B2 and B3 periprosthetic femoral fractures. JBJS Rev. 2021;9:e21.CrossRef
12.
Joestl J, Hofbauer M, Lang N, Tiefenboeck T, Hajdu S. Locking compression plate versus revision-prosthesis for Vancouver type B2 periprosthetic femoral fractures after total hip arthroplasty. Injury. 2016;47:939–43.PubMedCrossRef
13.
Timperley A, Gie G, Lee A, Ling R. The femoral component as a taper in cemented total hip arthroplasty. J Bone Joint Surg Br. 1993;75:S33.
14.
Solomon LB, Hussenbocus SM, Carbone TA, Callary SA, Howie DW. Is internal fixation alone advantageous in selected B 2 periprosthetic fractures? ANZ J Surg. 2015;85:169–73.PubMedCrossRef
15.
Mont MA, Maar DC. Fractures of the ipsilateral femur after hip arthroplasty: a statistical analysis of outcome based on 487 patients. J Arthroplasty. 1994;9:511–9.PubMedCrossRef
16.
Incavo SJ, Beard D, Pupparo F, Ries M, Wiedel J. One-stage revision of periprosthetic fractures around loose cemented total hip arthroplasty. Am J Orthop (Belle Mead NJ). 1998;27:35–41.PubMed
17.
Powell-Bowns MF, Oag E, Ng N, et al. Vancouver B periprosthetic fractures involving the exeter cemented stem: reducible fractures with intact bone-cement interfaces can be fixed. Bone Joint J. 2021;103:309–20.PubMedCrossRef
18.
Stoffel K, Blauth M, Joeris A, Blumenthal A, Rometsch E. Fracture fixation versus revision arthroplasty in Vancouver type B2 and B3 periprosthetic femoral fractures: a systematic review. Arch Orthop Trauma Surg. 2020;140:1381–94.PubMedPubMedCentralCrossRef
19.
Al-Najjim M, Khattak U, Sim J, Chambers I. Differences in subsidence rate between alternative designs of a commonly used uncemented femoral stem. J Orthop. 2016;13:322–6.PubMedPubMedCentralCrossRef
20.
Lindahl H, Malchau H, Oden A, Garellick G. Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br. 2006;88:26–30.PubMedCrossRef
21.
Duncan C. Fractures of the femur after hip replacement. Instr Course Lect. 1995;44:293–304.PubMed
22.
Chatziagorou G, Lindahl H, Garellick G, Kärrholm J. Incidence and demographics of 1751 surgically treated periprosthetic femoral fractures around a primary hip prosthesis. Hip Int. 2019;29:282–8.PubMedCrossRef
23.
Ireland N. Isle Of Man. 14th annual report (Hemel Hempstead, United Kingdom: National Joint Registry for England W). 2017.
24.
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(4):477–82.PubMedCrossRef
25.
Bennett DM, Koehler LR, Margolis DJ, et al. Predicting Vancouver Types B1 and B2 Periprosthetic Fractures of the Femur. UNM Orthop Res J. 2016;5:20.
26.
Barenius B, Inngul C, Alagic Z, Enocson A. A randomized controlled trial of cemented versus cementless arthroplasty in patients with a displaced femoral neck fracture: a four-year follow-up. Bone Joint J. 2018;100:1087–93.PubMedCrossRef
27.
Langslet E, Frihagen F, Opland V, Madsen JE, Nordsletten L, Figved W. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clin Orthop Relat Res. 2014;472:1291–9.PubMedCrossRef
28.
Zheng H, Gu H, Shao H, et al. Treatment and outcomes of Vancouver type B periprosthetic femoral fractures: a retrospective study of 97 cases. Bone Joint J. 2020;102:293–300.PubMedCrossRef
29.
Springer BD, Berry DJ, Lewallen DG. Treatment of periprosthetic femoral fractures following total hip arthroplasty with femoral component revision. JBJS. 2003;85:2156–62.CrossRef
30.
Smitham PJ, Carbone TA, Bolam SM, 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.PubMedCrossRef
31.
Kristensen T, Dybvik E, Furnes O, Engesæter L, Gjertsen J. More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures: a study from the Norwegian Hip Fracture Register 2005 to 2016. Bone Joint J. 2018;100:1565–71.PubMedCrossRef
32.
Foster AP, Thompson NW, Wong J, Charlwood AP. Periprosthetic femoral fractures–a comparison between cemented and uncemented hemiarthroplasties. Injury. 2005;36:424–9.PubMedCrossRef
33.
Arshi A, Lai WC, Iglesias BC, et al. Blood transfusion rates and predictors following geriatric hip fracture surgery. Hip Int. 2021;31:272–9.PubMedCrossRef
34.
35.
Zuurmond R, Van Wijhe W, Van Raay J, Bulstra S. High incidence of complications and poor clinical outcome in the operative treatment of periprosthetic femoral fractures: an analysis of 71 cases. Injury. 2010;41:629–33.PubMedCrossRef
36.
Phillips J, Boulton C, Moran C, Manktelow A. What is the financial cost of treating periprosthetic hip fractures? Injury. 2011;42:146–9.PubMedCrossRef
37.
Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2010;6.
38.
Inngul C, Blomfeldt R, Ponzer S, Enocson A. Cemented versus uncemented arthroplasty in patients with a displaced fracture of the femoral neck: a randomised controlled trial. Bone Joint J. 2015;97:1475–80.PubMedCrossRef
39.
Tsai M-C, Ng Y-Y, Chen W-M, Tsai S-W, Wu S-C. The effects of cement fixation on survival in elderly patients with hip hemiarthroplasty: a nationwide cohort study. BMC Musculoskelet Disord. 2019;20:1–8.CrossRef
40.
Dale H, Børsheim S, Kristensen TB, et al. Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the Norwegian arthroplasty register. Acta Orthop. 2020;91:152–8.PubMedCrossRef
41.
Ko PS, Lam JJ, Tio MK, Lee OB, Ip FK. Distal fixation with Wagner revision stem in treating Vancouver type B2 periprosthetic femur fractures in geriatric patients. J Arthroplasty. 2003;18:446–52.PubMedCrossRef
42.
Fink B, Grossmann A, Singer J. Hip revision arthroplasty in periprosthetic fractures of Vancouver type B2 and B3. J Orthop Trauma. 2012;26:206–11.PubMedCrossRef
43.
44.
Khanuja HS, Vakil JJ, Goddard MS, Mont MA. Cementless femoral fixation in total hip arthroplasty. JBJS. 2011;93:500–9.CrossRef
Metadata
Title
Outcomes of fixation of Vancouver B periprosthetic fractures around cemented versus uncemented stems
Authors
Ameen Barghi
Philip Hanna
Nelson Merchan
Michael J. Weaver
John Wixted
Paul Appleton
Edward Rodriguez
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2023
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-023-06359-0

Other articles of this Issue 1/2023

BMC Musculoskeletal Disorders 1/2023 Go to the issue

Research

Repeated intra-articular injections of umbilical cord-derived mesenchymal stem cells for knee osteoarthritis: a phase I, single-arm study

Research

Alteration in coracohumeral ligament and distance in people with symptoms of subcoracoid impingement

Research

Surgical interventions for symptomatic knee osteoarthritis: a network meta-analysis of randomized control trials

Research

Distal radius fractures in children aged 5–12 years: a Swedish nationwide register-based study of 25 777 patients

Research

A systematic review and meta-analysis comparing outcomes following total knee arthroplasty for rheumatoid arthritis versus for osteoarthritis

Research

Application of antibiotic bone cement in the treatment of infected diabetic foot ulcers in type 2 diabetes