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

Abstract

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.

Reply

“…It is our pleasure to reply to the letter by Fan and Huang (DOI: 10.1177/2309499019857653). 1 In our published manuscript, 2 the fracture type in Figure 2 was actually the Vancouver type B2 fracture (Figure 1). According to the preoperative radiographs, the stem seems to be stable.…”

A Comparison of Risks and Benefits Regarding Hip Arthroplasty Fixation

“…53 Although fractures around stable implants can be treated conservatively or with open reduction and internal fixation, 54 unstable implants require revision arthroplasty, 54 which, again, is associated with high morbidity and mortality. 45 , 46 Extensively porous-coated or titanium modular fluted tapered revision stems can be used as noncemented alternatives 55 – 57 to restore long-term implant stability. However, Munegato et al 55 detected a dislocation rate as high as 16% in patients receiving a titanium modular fluted tapered stem.…”

“…However, Munegato et al 55 detected a dislocation rate as high as 16% in patients receiving a titanium modular fluted tapered stem. Further complicating the matter, cement can extravasate into the fracture gap during PFF revision, potentially causing late-onset periprosthetic fractures and malunion, whereas porous-coated stems are associated with a low refracture rate of 3.4% 56 and a stable bony ingrowth of 98% or above. 56 , 57 The risk of cortical perforation with extrusion of cement increases even further during the process of previous cement removal of primarily cemented THAs.…”

“…Further complicating the matter, cement can extravasate into the fracture gap during PFF revision, potentially causing late-onset periprosthetic fractures and malunion, whereas porous-coated stems are associated with a low refracture rate of 3.4% 56 and a stable bony ingrowth of 98% or above. 56 , 57 The risk of cortical perforation with extrusion of cement increases even further during the process of previous cement removal of primarily cemented THAs. Briant-Evans et al, 58 therefore, suggested a cement-in-cement approach in selected cases with a well-preserved preexisting cement mantle.…”

Letters about Published Papers

“…We read with interest the paper by Wang et al 1 However, there is a different view of the fracture type in Figure 2. We think that this is Vancouver type B1 fracture, rather than the type B2.…”