Revision Arthroplasty Versus Open Reduction and Internal Fixation of Vancouver Type-B2 and B3 Periprosthetic Femoral Fractures

Abstract

Revision arthroplasty (RA) continues to be considered the gold standard in the surgical treatment of Vancouver type-B2 and B3 periprosthetic femoral fractures. However, open reduction and internal fixation (ORIF) has been associated with satisfactory outcomes. Thus, there is an ongoing discussion regarding the optimal surgical strategy for the treatment of these fractures.In this systematic review and meta-analysis, no significant differences in clinical and radiographic outcome were observed between ORIF and RA in the treatment of Vancouver type-B2 periprosthetic femoral fractures.ORIF of Vancouver type-B3 periprosthetic femoral fractures was associated with higher revision and reoperation rates than those after RA.Compared with RA, a significantly higher rate of subsidence was found in the ORIF group in Vancouver type-B2 periprosthetic femoral fractures whereas no significant difference in terms of loosening was observed.In the comparison of RA and ORIF for the treatment of Vancouver type-B2 and B3 fractures, the percentage of patients achieving full weight-bearing did not differ significantly.Mortality rates did not differ between RA and ORIF in the treatment of Vancouver type-B2 and B3 fractures.Overall complication rates did not differ between RA and ORIF in the treatment of Vancouver type-B2 and B3 fractures.We found a high heterogeneity in applied surgical and fixation techniques in the ORIF group.

Periprosthetic fracture management of the proximal femur

“…Haider et al also found revision figures of 22.9% versus 13.5%, with ORIF versus revision arthroplasty, respectively, a difference that was only found in B3 and not in B2 fracture types. 43,55…”

“…The latter group had lower rates of reoperation, lower rates of loosening of the femoral component, and better results in the Parker Mobility Score. 55…”

“…Haider et al also found revision figures of 22.9% versus 13.5%, with ORIF versus revision arthroplasty, respectively, a difference that was only found in B3 and not in B2 fracture types. 43,55 Recently, a systematic review and meta-analysis conducted by Haider et al compared the management of revision arthroplasty versus osteosynthesis in Vancouver B2 and B3 periprosthetic fractures. In 33 studies with 2509 patients, they found that, unlike B2 subtypes, the results of osteosynthesis in B3 subtypes were not comparable with those of revision arthroplasty.…”

Outcomes of fixation of Vancouver B periprosthetic fractures around cemented versus uncemented stems

“…There is increasing evidence in the trauma literature that fixation of these types of fractures may offer similar outcomes to revision arthroplasty, particularly in older patients with decreased functional demand [9]. More recently, studies have found similar outcomes when managing B2 and B3 fractures with open reduction and internal fixation (ORIF) when compared to RA [9][10][11]. At our institution periprosthetic fractures, including all Vancouver B variants, are primarily treated with fixation and only revised if the stability of the original stem cannot be achieved.…”

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

“…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).…”