Management of Vancouver B2 Periprosthetic Femoral Fractures, Revision Total Hip Arthroplasty Versus Open Reduction and Internal Fixation: A Systematic Review and Meta-Analysis

Abstract

Objective: To identify and analyze the current evidence for the use of open reduction and internal fixation (ORIF) constructs compared with conventional revision total hip arthroplasty (rTHA) for the management of Vancouver B2 periprosthetic femoral fractures (PFFs).Data Sources: A systematic literature search of the MEDLINE, CINAHL, and EMBASE databases was conducted. Prospective and retrospective studies were eligible. No limitation was placed on publication date, with only articles printed in English eligible.Study Selection: Included studies were retrospective studies comparing ORIF and rTHA for the management of Vancouver B2 PFFs.Data Extraction: The primary outcome was the overall complication rate. Other outcomes included as rate of dislocation, revision operation, refracture, infection, nonunion, and subsidence/loosening. Twenty-four studies were included totaling 1621 patients, of which 331 were treated with ORIF and 1280 with rTHA. Conclusion:The 1621 patients included comprised a mixture of different fracture patterns, prostheses, and patient comorbidities. The overall complication rate for ORIF was 24% versus 18% for rTHA (P = 0.13). The results demonstrate that rTHA has a similar revision rate to ORIF in PFFs with a loose femoral component and adequate bone stock. ORIF was superior to rTHA in prevention of postoperative dislocation; however, there was no difference between other complications. This review suggests a potential role of both ORIF and rTHA in the management of Vancouver B2 PFFs.

Treatment algorithm in Vancouver B2 periprosthetic hip fractures: osteosynthesis vs revision arthroplasty

“…While RA is likely to remain the mainstay of treatment, ORIF should be considered in patients where RA is not ideal. Furthermore, the results show that if ORIF is performed, the outcomes are not disastrous as convention would have us believe and may offer a benefit over RA, although further research will help identify patients who may benefit from ORIF over RA (10).…”

“…Recently, there has been a debate on the need to follow these recommendations in all patients. Various authors have argued that, in certain circumstances, VB2 PPHF could be successfully treated using the ORIF technique (3,8,9,10). For this reason, in some studies, ORIF has been compared to revision arthroplasty (RA) for this type of fracture, and equivalent if not better results have been obtained (8,11,12,13,14,15,16,17).…”

“…In a recent metanalysis, Lewis et al (10) state that RA has a similar revision rate to ORIF in VB2 PPHF. Fewer dislocations were seen in the ORIF group; however, there was no difference between other complications.…”

Analysis of complications in 97 periprosthetic Vancouver B2 fractures treated either by internal fixation or revision arthroplasty

“…Previously, RA was thought to be the only possible treatment for Vancouver B2 fractures but newer evidence suggests that ORIF is a viable treatment option in select cases [ 3 , 6 – 8 , 12 , 13 ]. A recent review with pooled data from 1622 patients treated for Vancouver B2 fractures found that 21% of the patients were treated with ORIF.…”

“…The overall revision rate was 14% and 18% after RA and ORIF, respectively. The dislocation rate after RA was higher than after ORIF but with regard to other complications and reoperation rates, there was no significant difference between RA and ORIF [ 12 ]. Another large review with pooled data from 2509 patients included both Vancouver B2 and B3 fractures.…”