Surgical treatment of Vancouver type B periprosthetic femoral fractures

Abstract

Aims We investigated patient characteristics and outcomes of Vancouver type B periprosthetic fractures treated with femoral component revision and/or osteosynthesis. Patients and Methods The study utilized data from the Swedish Hip Arthroplasty Register (SHAR) and information from patient records. We included all primary total hip arthroplasties (THAs) performed in Sweden since 1979, and undergoing further surgery due to Vancouver type B periprosthetic femoral fracture between 2001 and 2011. The primary outcome measure was any further reoperation between 2001 and 2013. Cross-referencing with the National Patient Register was performed in two stages, in order to identify all surgical procedures not recorded on the SHAR. Results Out of 1381 Vancouver type B fractures that fulfilled the inclusion criteria, 257 underwent further reoperation by the end of 2013. Interprosthetic and Type B1 fractures had a higher risk for reoperation. For B1 fractures, the rate of reoperation did not differ (p = 0.322) after use of conventional (26%) or locking plate osteosynthesis (19%). No significant differences were observed between cemented, cementless monoblock, and cementless modular revision components for the treatment of type B2 and B3 fractures. Conclusion In this country-specific study, the choice of locking or conventional plates for the treatment of type B1, and cemented or cementless femoral components fixation for B2 and B3 fractures, had no significant influence on risk for reoperation. Interprosthetic fractures adversely affected the outcome of treatment of type B fractures. Differences in the patient characteristics of the compared groups were observed. Cite this article: Bone Joint J 2019;101-B:1447–1458.

Current Practice of Italian Association of Revision Surgery Members in the Treatment of Unified Classification System Type B Periprosthetic Femoral Fracture Around Hip Arthroplasty: A Cross-Sectional Survey

“…This preference is a clear example of discrepancy between surgeons opinions and current evidence because the same authors made a systematic review where they found a higher rate of nonunion and increased risk of hardware failure by using locking plate alone instead of cable plate. 15 …”

Treatment Algorithm of Periprosthetic Femoral Fracturens

“…The treatment of PFFs depends on 5 important factors: level of fracture, stability of the implant and of the fracture, quality and quantity of bone stock, patient’s factors (as age, comorbidities and functional demands), and surgeon experience. 2 , 10 , 22 , 31 - 33 The aim of this review is to describe state-of-the-art treatment in the management of PFFs, and to propose a summary to guide treatment choice.…”

Periprosthetic femoral fractures around the original cemented polished triple-tapered C-stem femoral implant: a consecutive series of 500 primary total hip arthroplasties with an average follow-up of 15 years

“…The true incidence of PFF remains unknown, but a prevalence of 0.1–4% has previously been estimated [ 3 , 7 – 9 ]. National joint registries, except the Swedish Hip Arthroplasty Registry, record only those PFFs which necessitate revision, failing to capture those managed non-operatively or by ORIF [ 10 , 11 ].…”