Outcomes of Vancouver B2 and B3 periprosthetic femoral fractures after total hip arthroplasty in elderly patients

Moreta, Jesús; Uriarte, Iker; Ormaza, Amaia; Mosquera, J.; Iza, Kattalin; Aguirre, Urko; Legarreta, María José; Mozos, José Luis Martínez-De Los

doi:10.1177/1120700018772163

Cited by 30 publications

(50 citation statements)

References 20 publications

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“…Infection rates in revision surgery are higher than in primary arthroplasty, ranging between 2% to 7% as reported in cases of femoral revision for PFF. 8,12,16,21,23,36,37 When treating periprosthetic fractures, the reoperation rate is reported to be high: 29 in our series it is around 12%. Chatziagorou et al 35 found that the reoperation rate did not statistically differ between cementless modular (16.2%), cementless monoblock (13.6%) and cemented stems (13.2%); in cementless stems the major reason for reoperation was hip dislocation (modular 5.4%; monoblock 6.8%), while in cemented stem it was nonunion.…”

Section: Discussionmentioning

confidence: 48%

“…An increased risk of dislocation is reported in patients with abductor mechanism insufficiency 38 or in patients with a mean subsidence of 4 mm compared to those with a mean subsidence of 0.89 mm. 36 Another important complication is periprosthetic infection; we reported 2 (8%) cases of infection. Infection rates in revision surgery are higher than in primary arthroplasty, ranging between 2% to 7% as reported in cases of femoral revision for PFF.…”

Section: Discussionmentioning

confidence: 74%

“…However, a significant decrease of deambulation was found after periprosthetic fractures. Moreta et al 36 reported that 41.9% of patients had not regained their pre-fracture walking status at the most recent follow-up. The percentage of patients who were not able to walk increased after the fracture from 0% to 7%, while the percentage needing a walker frame or 2 crutches increased from 7% to 20.9%.…”

Section: Discussionmentioning

confidence: 99%

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Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes

et al. 2020

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Introduction: The aim of the study was to evaluate the mortality and the outcomes of femoral revision in periprosthetic femoral fractures (PFF) using a titanium modular fluted tapered stem. Methods: We retrospectively reviewed femoral revisions performed for PFF with a titanium modular fluted tapered stem in 25 patients. The average age was 74.32 years. In 21 patients the type of fracture was Vancouver B2 and type B3 in 4 cases. The mean follow-up was 29.16 (0.83–104.1) months SD ± 29.49. Results: The 30-day and 1-year mortality were 8% and 12% respectively. The mean value of the Charlson Comorbidity Index was 4.8 and the mean value of ASA score was 2.4. The average time to surgery from admittance was 5.45 days with 20% of patients operated on within 48 hours. A significant correlation was found between ASA score and mortality. The mean HHS was 76 points; good-excellent results were recorded in 56% of patients. 72% had no pain and 28% had slight pain (VAS 1–3). 52% of patients were able to walk without pain, limp or aids. The mean implant subsidence was 1.57 mm and superior to 5 mm in 2 cases. As complications we recorded 4 implant dislocations (16%) and 2 infections. Reoperation rate was 12%. Conclusions: Femoral revision with a modular fluted tapered stem in patients with periprosthetic fractures results in good clinical and radiological outcomes. However, mortality remains high and, despite the modularity design, dislocation is the most frequent complication.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes

et al. 2020

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“…All patients had achieved fracture union by the final follow-up, and the length of femoral stem fixation beyond the distal end of the fracture was greater than 4 cm, which matched well with the femur. The patients in our study achieved better clinical outcomes compared to those in previous studies, 11,33 –37 such as Harris Hip score (Table 5). Further studies with larger sample sizes will be required to determine whether this method will be effective for routine treatment of Vancouver type B2 PFFs.…”

Section: Discussionsupporting

confidence: 42%

“…Our study involves longer follow-up (102 ± 24.5 months) than most previous studies, which followed up for 14.5–60 months. 11,33 –37 Nevertheless, our study still has several limitations. First, the sample is relatively small, so statistical power is low.…”

Section: Discussionmentioning

confidence: 91%

Uncemented extensive porous titanium-coated long femoral stem prostheses are effective in treatment of Vancouver type B2 periprosthetic femoral fractures: A retrospective mid- to long-term follow-up study

Wang

Kang

2019

J Orthop Surg (Hong Kong)

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The aim of this study was to evaluate the mid-to long-term outcomes of revision surgery for Vancouver type B2 periprosthetic femoral fractures (PFFs) after total hip arthroplasty using an uncemented extensive porous titaniumcoated long femoral stem prosthesis (solution prosthesis) with or without cortical strut allograft. Methods: A total of 34 patients with Vancouver type B2 PFFs who underwent revision hip arthroplasty using a posterolateral approach and received a solution prosthesis at our institution from December 2006 to January 2014 were retrospectively recruited. Patients were asked to assess their walking ability and pain status using a questionnaire. Limb function, pain, and physical and mental health were assessed using the Harris Hip score, University of California-Los Angeles score, Western Ontario and McMaster Universities osteoarthritis index, and Short Form-12 Health Survey score. Patients were also asked to rate their satisfaction with the surgery. Fracture union and stress shielding were assessed by radiography, and computed tomography was used to assess stem fixation. Single-photon emission computed tomography performed to assess radionuclide distribution in patients given cortical strut allografts. Patients were asked about their condition before PFF and evaluated at 6 weeks, 3 months, 6 months, 1 year, and annually after surgery. Any complications during follow-up were recorded. Results: Of the 34 patients, 29 completed follow-up. There was no significant difference in patient's health before PFF or at the last follow-up. Fracture union was achieved in all patients. Mild-to-moderate stress shielding occurred in three patients, and no patients exhibited femoral stem loosening or obvious subsidence. Radionuclides were concentrated in the cortical strut transplantation area, and the cortical strut was integrated with the host femur. The incidence of postoperative complications was low. Conclusions: Revision surgery using the solution prosthesis with or without cortical strut allograft is effective in treating Vancouver type B2 PFFs, with satisfactory mid-and long-term clinical and radiological outcomes.

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Periprosthetic Hip Fractures

Díaz-Dilernia,

Rajput,

Haddad

2024

Orthopaedics and Trauma

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Outcomes of Vancouver B2 and B3 periprosthetic femoral fractures after total hip arthroplasty in elderly patients

Abstract: Although we reported good results of fracture healing, there were functional impairment and a high rate of complications, especially dislocation, in Vancouver B2 and B3 periprosthetic fractures in elderly patients.

Cited by 30 publications

References 20 publications

Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes

Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes

Uncemented extensive porous titanium-coated long femoral stem prostheses are effective in treatment of Vancouver type B2 periprosthetic femoral fractures: A retrospective mid- to long-term follow-up study

Periprosthetic Hip Fractures

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