Modular Fluted Tapered Stems for Periprosthetic Femoral Fractures

Abstract

Background:Modular fluted tapered (MFT) stems have advanced treatment of Vancouver B2 and B3 periprosthetic femoral fractures, but series to date have been limited with respect to cohort size and follow-up duration. The purpose of this study was to determine implant survivorship, radiographic results, complications, and clinical outcomes of Vancouver B2 and B3 periprosthetic femoral fractures treated with MFT stems in a large series of patients.Methods:We identified 171 Vancouver B2 (109) and B3 (62) periprosthetic femoral fractures treated with an MFT stem between 2000 and 2018 using our institutional total joint registry. The mean age was 75 years, 50% were female, and the mean body mass index was 29 kg/m2. The median stem diameter was 18 mm and median stem length was 210 mm. The cumulative incidences of revision and reoperation with death as the competing risk were calculated, radiographs were reviewed, and clinical outcomes were evaluated using the Harris hip score (HHS). The mean follow-up was 5 years.Results:The 10-year cumulative incidence of any revision was 10%. There were 17 revisions, of which only 3 were for the distal fluted portion of the MFT stem. Revision indications included periprosthetic joint infection (PJI) (n = 6) and dislocation (n = 11). The 10-year cumulative incidence of any reoperation was 15%. In addition to the above 17 revisions, there were 7 reoperations for superficial wound complications (n = 4), Vancouver B1 periprosthetic femoral fracture (n = 1), vascular occlusion (n = 1), and acetabular cartilage degeneration requiring an acetabular component (n = 1). Radiographically, there was 1 fracture nonunion. All unrevised MFT stems were radiographically well fixed. Subsidence of ≥5 mm occurred in 11%, but all implants were stable at the most recent follow-up. The mean HHS was 75 at 2 years (n = 71).Conclusions:In this large series of 171 Vancouver B2 and B3 periprosthetic femoral fractures treated with MFT stems, we found that such constructs were associated with a high rate of fracture healing and provided extremely reliable and durable implant fixation, with no revisions for aseptic loosening. Dislocation and PJI were the most common complications.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Revision Total Hip Arthroplasty with a Modular Fluted Tapered Stem for a Periprosthetic Femoral Fracture

“…Contemporary series have demonstrated that the use of a modular fluted tapered stem leads to improved implant survivorship and clinical outcomes with lower complication rates for Vancouver B2 and B 3 periprosthetic femoral fractures 1,10-12,14-19 .…”

“…As a result of these unique advantages, these stems were introduced several years ago for the treatment of Vancouver B 2 or B 3 periprosthetic femoral fractures. Expected Outcomes: Contemporary series have demonstrated that the use of a modular fluted tapered stem leads to improved implant survivorship and clinical outcomes with lower complication rates for Vancouver B2 and B 3 periprosthetic femoral fractures 1,[10][11][12][14][15][16][17][18][19] . Important Tips:…”

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Background: As the number of primary total hip arthroplasty procedures performed each year continues to rise, so too do the number of complications, including periprosthetic femoral fracture [1][2][3][4][5][6][7][8][9] . Vancouver B2 and B3 periprosthetic femoral fractures are difficult to treat because they require the surgeon to simultaneously manage a femoral fracture and gain new implant fixation.

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Monoblock tapered stems in management of UCS B2 and B3 periprosthetic fractures in revision total hip arthroplasty

“…These have shown challenges in management due to difficulties in treating the fracture in tandem with managing the loose implant, requiring revision total hip arthroplasty (rTHA) surgery, as well as fracture fixation. [1][2][3][4] UCS B2 and B3 fractures have been traditionally managed with the use of modular long porous-coated tapered cementless stems with optional use of proximal bone allograft and cerclage cables. 3,[5][6][7][8] The construct popularity has been attributed to multiple factors, such as control in the adjustment of leg length, neck anteversion, and offset following implantation of the distal fixation portion of the stem, in addition to imparting stability distal to the PPFx while maintaining the proximal femoral bone.…”

“…[1][2][3][4] UCS B2 and B3 fractures have been traditionally managed with the use of modular long porous-coated tapered cementless stems with optional use of proximal bone allograft and cerclage cables. 3,[5][6][7][8] The construct popularity has been attributed to multiple factors, such as control in the adjustment of leg length, neck anteversion, and offset following implantation of the distal fixation portion of the stem, in addition to imparting stability distal to the PPFx while maintaining the proximal femoral bone. 3,[5][6][7][8] However, studies have also shown several disadvantages, such as higher rates of stem subsidence and intraoperative fracture, as well as implant failures including corrosion and junctional fractures at the proximal and distal segments of the prosthesis.…”