Top

European Journal of Orthopaedic Surgery & Traumatology

Published in:

01-08-2018 | Original Article • HIP - ARTHROPLASTY

Vancouver B2 periprosthetic femoral fractures: a comparative study of stem revision versus internal fixation with plate

Authors: Mauro Spina, Andrea Scalvi

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 6/2018

Abstract

Introduction

The aim is to compare stem revision versus internal fixation with plate in the treatment of Vancouver B2 periprosthetic femoral fractures.

Materials and methods

This is a retrospective review of 34 consecutive patients admitted from June 1998 to May 2017. One patient was treated conservatively, 11 with stem revision (group 1), 20 with plate, screws and cerclage (group 2), one patient with cerclage alone and another by Girdlestone procedure. We assessed surgical complications, mortality within 1 year, functional outcome with Harris Hip Score and radiographic outcome with Beals and Tower’s criteria.

Results

At an average follow-up of 30.1 months in group 1, we had 36.4% of patients with complications, HHS of 66.8, radiographic outcome “excellent-good” in 91% of cases. In group 2 we had 25% of patients with complications, HHS of 71.8, radiographic outcome “excellent-good” in 80% of cases. There were no significant differences in 1-year mortality between the two groups. In group 2, the best outcomes were obtained in uncemented straight stems with Johansson type 1 fracture and in cemented polished stems with stem detachment from the cement–bone complex. Whatever treatment was adopted, there was an overall worsening in quality of life.

Conclusions

Stem revision remains the treatment of choice in Vancouver B2 fractures, but, in selected cases, internal fixation with plate, screws and cerclage can be a viable alternative option.

Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304PubMed

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

Marshall RA, Weaver MJ, Sodickson A, Khurana B (2017) Periprosthetic femoral fractures in the emergency department: what the orthopedic surgeon wants to know. Radiographics 37(4):1202–1217CrossRefPubMed

Beals RK, Tower SS (1996) Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res 327:238–246CrossRef

Lindahl H, Malchau H, Odén A, Garellick G (2006) Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br 88(1):26–30CrossRefPubMed

Dennis MG, Simon JA, Kummer FJ, Koval KJ, DiCesare PE (2000) Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques. J Arthroplasty 15(4):523–528CrossRefPubMed

Katzer A, Ince A, Wodtke J, Loehr JF (2006) Component exchange in treatment of periprosthetic femoral fractures. J Arthroplasty 21(4):572–579CrossRefPubMed

Masri BA, Meek RM, Duncan CP (2004) Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 420:80–95CrossRef

Young SW, Walker CG, Pitto RP (2008) Functional outcome of femoral peri prosthetic fracture and revision hip arthroplasty: a matched-pair study from the New Zealand Registry. Acta Orthop 79(4):483–488CrossRefPubMed

10.

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

11.

Christophe A, Troussel S, Detrembleur C, Putineanu D (2017) Surgery of Vancouver type B2 periprosthetic femoral fracture after total hip arthroplasty in elderly patients: an alternative way with internal fixation. SM Gerontol Geriatr Res 1(2):1006

12.

Brady OH, Garbuz DS, Masri BA, Duncan CP (2000) The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty 15(1):59–62CrossRefPubMed

13.

Johansson JE, McBroom R, Barrington TW, Hunter GA (1981) Fracture of the ipsilateral femur in patients with total hip replacement. J Bone Joint Surg Am 63(9):1435–1442CrossRefPubMed

14.

Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51(4):737–755CrossRefPubMed

15.

Tower SS, Beals RK (1999) Fractures of the femur after hip replacement: the Oregon experience. Orthop Clin N Am 30(2):235–247CrossRef

16.

Khan T, Grindlay D, Ollivere BJ, Scammell BE, Manktelow AR, Pearson RG (2017) A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Joint J 99-B(4 Supple B):17–25CrossRefPubMed

17.

Ko PS, Lam JJ, Tio MK, Lee OB, Ip FK (2003) Distal fixation with Wagner revision stem in treating Vancouver type B2 periprosthetic femur fractures in geriatric patients. J Arthroplasty 18(4):446–452CrossRefPubMed

18.

Marx A, Beier A, Jung L, Lohmann CH, Halder AM (2012) Peri-prosthetic femoral fractures treated with the uncemented Wagner revision stem. Hip Int 22(3):286–291CrossRefPubMed

19.

Haasper C, Enayatollahi MA, Gehrke T (2015) Treatment of Vancouver type B2 periprosthetic femoral fractures. Int Orthop 39(10):1989–1993CrossRefPubMed

20.

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

21.

Niikura T, Lee SY, Sakai Y, Nishida K, Kuroda R, Kurosaka M (2014) Treatment results of a periprosthetic femoral fracture case series: treatment method for Vancouver type B2 fractures can be customized. Clin Orthop Surg 6(2):138–145CrossRefPubMedPubMedCentral

22.

Mulay S, Hassan T, Birtwistle S, Power R (2005) Management of types B2 and B3 femoral periprosthetic fractures by a tapered, fluted, and distally fixed stem. J Arthroplasty 20(6):751–756CrossRefPubMed

23.

Gitajn IL, Heng M, Weaver MJ, Casemyr N, May C, Vrahas MS, Harris MB (2017) Mortality following surgical management of Vancouver B periprosthetic fractures. J Orthop Trauma 31(1):9–14CrossRefPubMed

24.

de Boer FA, Sariali E (2017) Comparison of anatomic vs. straight femoral stem design in total hip replacement—femoral canal fill in vivo. Hip Int 27(3):241–244CrossRefPubMed

25.

Timperley AJ, Gie GA, Lee AJ, Ling RS (1993) The femoral component as a taper in cemented total hip arthroplasty. J Bone Joint Surg Br 75(Suppl I):33

26.

Moreta J, Aguirre U, de Ugarte OS, Jáuregui I, Mozos JL (2015) Functional and radiological outcome of periprosthetic femoral fractures after hip arthroplasty. Injury 46(2):292–298CrossRefPubMed

27.

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 23(5):545–552CrossRefPubMed

28.

Neumann D, Thaler C, Dorn U (2012) Management of Vancouver B2 and B3 femoral periprosthetic fractures using a modular cementless stem without allografting. Int Orthop 36(5):1045–1050CrossRefPubMed

Title: Vancouver B2 periprosthetic femoral fractures: a comparative study of stem revision versus internal fixation with plate
Authors: Mauro Spina
Andrea Scalvi
Publication date: 01-08-2018
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 6/2018
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-018-2181-3

At a glance: The STEP trials

Springer Medicine

Vancouver B2 periprosthetic femoral fractures: a comparative study of stem revision versus internal fixation with plate

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2018

Fixation method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis

Vialle Luiz Roberto (Ed), Jeffrey C. Wang, Claudio Lamartina (Guest Eds): AOSpine masters series vol 8

RETRACTED ARTICLE: Biceps tendon interposition in two-part fracture of the humeral surgical neck

Traumatic cervical spine injuries in a patient with pycnodysostosis

Preoperative embolization and local hemostatic agents in palliative decompression surgery for spinal metastases of renal cell carcinoma

Influence of synovectomy on blood loss and need for transfusion in standard total knee replacement