Hip Revision Arthroplasty of Periprosthetic Fractures Vancouver B2 and B3 with a Modular Revision Stem: Short-Term Results and Review of Literature

Abstract

Background Periprosthetic fractures Vancouver type B2/B3 after total hip arthroplasty (THA) is a challenging entity with increasing numbers. Limited data are available for this type of fracture treated with modular stems. Therefore, this study evaluated the outcome of Vancouver type B2/B3 fractures treated with a modular hip revision stem using a subproximal/distal anchorage and compared it to the current literature. Materials and Methods A consecutive series of periprosthetic Vancouver type B2/B3 fractures treated with a modular revision stem was retrospectively (2013 – 2016) evaluated. Assessment included the clinical (HHS, pain, ROM) as well as the radiological outcome (subsidence, loosening, facture healing). In adddition, the surgical technique is described in detail and results are compared with the current literature. Results A total of 18 patients (female/male 12/6) with Vancouver B2/B3 (n = 12/6) fractures with a mean age of 75.5 (60 – 89) years were included. The revision stem was inserted via a modified transgluteal approach (n = 16) or classical transfemoral approach (n = 2). The mean follow-up was 18.5 months, with a mean Harris Hip Score of 72.5 ± 18.7 (35.0 – 99.0) points. The fracture healing rate was 94.4% (n = 17) with osseous integration according to Engh in all cases. Dislocations of the greater trochanter were recorded in seven patients (38.9%). According to Beals and Towers, all results were rated excellent or good. No implant-related failure or relevant subsidence during this time was observed. Major complications were observed in five patients with two periprosthetic joint infections and two cases of major revision surgery. Conclusion This study assessing Vancouver B2/3 fractures shows reproducible, good, short-term results in terms of subsidence and clinical functional outcome by the use of a modular revision stem. The transfemoral approach together with the modular stem allows for a stable fixation and good fracture healing. However, our data and review of the literature also documents the difficulties and higher complication rate associated with Vancouver B2/3 fractures.

Outcomes After Operative Fixation of Vancouver B2 and B3 Type Periprosthetic Fractures

“…Our study is in line with other studies, however, that found subsidence in revision arthroplasty patients that ranged from 9.1% to 77.3%. 38 Our study was limited by several factors. Primarily, our retrospective design has no random allocation.…”

“…Our study is in line with other studies, however, that found subsidence in revision arthroplasty patients that ranged from 9.1% to 77.3%. 38…”

Analysis of modular taper fractures of the revision hip stem Prevision and comparison of the original and current taper design

“…Both modular and nonmodular tapered cementless revision stems generally show satisfactory results. [2][3][4][5][6] Currently, there is no evidence for the superiority of either design, and there are no scientifically based indications for choosing between modular and non-modular prostheses. In a systematic review comparing monobloc and modular revision hip stems, similar re-revision rates, dislocation rates, periprosthetic fracture rates, and infection rates were observed.…”

“…The comparison of the outcome of different revision stem designs in the literature is also limited due to variations in implant designs, indications, and patient cohorts. 6 An important aspect of modular hip stems is the biomechanical safety of the modular connection. 8,9 Particularly in the absence of proximal bone support, the connection between the proximal and distal components has to carry the entire load from the hip joint to the distal femur.…”

“…The comparison of the outcome of different revision stem designs in the literature is also limited due to variations in implant designs, indications, and patient cohorts. 6…”