Is internal fixation alone advantageous in selected <scp>B</scp>2 periprosthetic fractures?

Solomon, Lucian B.; Hussenbocus, Saleem M.; Carbone, Tania A.; Callary, Stuart A.; Howie, Donald W.

doi:10.1111/ans.12884

Cited by 47 publications

(53 citation statements)

References 20 publications

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“…Our systematic search identified 14 original studies that included patients treated with ORIF and patients treated with revision arthroplasty in the treatment of B2 and B3 PFF [5,16,[19][20][21][22][23][24][25][26][27][30][31][32]. The publications were mainly retrospective cohort studies which did not describe the treatment allocation, provided little information about potential predictive factors and presented diverse outcome parameters.…”

Section: Resultsmentioning

confidence: 99%

“…Only few studies provided a rigorous statistical analysis [16,19,21,23,32]. Whereas some of these studies could show significant advantages of ORIF for various in-hospital parameters [16,19,21], this was not the case for postoperative clinical outcomes: Only one study found a significant difference, namely the postoperative weight bearing instructions as given by the treating physician, which allowed more weight bearing after revision arthroplasty than after ORIF, and thus was in favor of revision surgery [21]. Various studies found n.s.…”

Section: Discussionmentioning

confidence: 99%

“…Various studies found n.s. trends in postoperative outcome parameters either in favor of ORIF [19,23], in favor of revision [32] or balanced [16], i.e. some parameters were in favor of ORIF; others in favor of stem revision.…”

Section: Discussionmentioning

confidence: 99%

“…The conception that ORIF could be advantageous in PFF around certain loose stems is supported by several reports where ORIF was compared to stem revision in B2 and/or B3 fractures and resulted in equivalent, if not better, outcomes [5,16,[19][20][21][22][23][24][25][26][27].…”

Section: Current Treatment Recommendations Under Debatementioning

confidence: 99%

“…trends in favor of revision surgery for mobility. However, the authors pointed out that the mean age in the revision group was 9 years higher and that one of the nine patients in the revision group had been evaluated for mobility directly after having received a knee replacement to explain the latter trend [16]. Antoniadis et al compared results of ORIF to stem revision in 53 patients who had sustained B2 fractures with an unknown fixation type of the initial stem.…”

Section: Success Of Treatment Modalitymentioning

confidence: 99%

See 4 more Smart Citations

Fracture fixation versus revision arthroplasty in Vancouver type B2 and B3 periprosthetic femoral fractures: a systematic review

Stoffel

Blauth

Joeris

et al. 2020

Arch Orthop Trauma Surg

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Introduction Hip arthroplasty (HA) is commonly performed to treat various hip pathologies. Its volume is expected to rise further due to the increasing age of the population. Complication rates are low; however, periprosthetic femoral fractures (PFF) are a rare, albeit serious, complication with substantial economic impact. While current guidelines propose revision with long-stemmed prostheses for all Vancouver B2 and B3 PFF, some recent research papers suggest that open reduction with internal fixation (ORIF) could lead to an equivalent outcome. Our aim was to summarize the evidence, elucidating under which circumstances ORIF leads to a favorable outcome after B2 and B3 PFF compared with revision surgery. Materials and methods A systematic literature search was performed to identify studies on patients treated with ORIF and with stem revision after B2 and/or B3 fractures. Extracted information included initial pathology, stem fixation mechanism, bone quality and stem stability at the time of PFF, clinical outcomes, and mortality. Results of individual studies were summarized in a table in lieu of a quantitative data synthesis due to a lack of standardized information. Results We identified 14 original research articles including both patients treated with ORIF and with stem revision after B2 and/or B3 PFF. Five studies included statistical comparisons, all were in favor of ORIF or indeterminate. The common lack of rigorous statistical analyses and significant methodological weaknesses made identification of outcome predictors impossible. Conclusion The choice of treatment modality for PFF depends on fracture, implant, and bone characteristics. Recent data show that successful outcome can be achieved without revising loose stems. ORIF may be a viable option if bone stock is adequate around uncemented or tapered polished stems with an intact cement mantle and the fracture geometry allows stable anatomic reconstruction. Conceptional considerations support this idea, but more data are needed to identify outcome predictors.

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