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

González-Martín, David; País-Brito, José Luis; González-Casamayor, Sergio; Guerra-Ferraz, Ayron; Ojeda-Jiménez, Jorge; Herrera-Pérez, Mario

doi:10.1530/eor-21-0129

Cited by 12 publications

(3 citation statements)

References 51 publications

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“…However, it has the drawback of causing more significant damage to the femoral bone stock, making future RA procedures more challenging [ 11 , 13 ]. ORIF was performed for certain type injuries in patients who were not medically fit for RA, particularly when dealing with elderly patients with multiple comorbidities, while RA was chosen for other cases [ 5 , 9 , 12 , 26 , 33 ]. Previous meta-analysis including 1621 patients demonstrates that RA has a similar revision and complication rate to ORIF in Vancouver B2 PFFs [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Long stem revision versus short stem revision with plate osteosynthesis for Vancouver type B2 periprosthetic femoral fracture: a comparative study of eighty five cases

Chen,

Hung,

Liou

et al. 2024

International Orthopaedics (SICOT)

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Purpose Periprosthetic femoral fractures (PPFs) around the hip are challenging complications in orthopaedic surgery, particularly Vancouver type B2 (VTB2) fractures. The surgical management of these fractures is crucial and depends on various factors. Cementless short taper stem with plate osteosynthesis is an alternative surgical technique. This study aims to compare the outcomes of this surgical technique with revision arthroplasty (RA) with long stem in the treatment of VTB2 PPFs. Methods This retrospective study was conducted in a single medical institute from February 2010 to May 2019. Patients who had received either total hip arthroplasty or bipolar hemiarthroplasty and subsequently developed a VTB2 PPF were included; patients who sustained intra-operative fractures or received a cemented stem previously were excluded from the analysis. The patients were divided into two groups: group I received RA with cementless long stem, while group II underwent RA with cementless short taper stem with plate osteosynthesis. Demographic data, radiographic and functional outcomes, and complications were analyzed between the two groups. Results A total of 85 patients diagnosed with VTB2 PPFs were included in the study. There were no significant differences between the two groups in terms of demographic data, including age, gender, mean follow-up times, estimated blood loss, and operative times. The radiographic results showed that there was no significant difference in the incidence of subsidence and implant stability between the two groups. However, group II tended to have less subsidence and periprosthetic osteolysis. Patients in group II had significantly better functional scores (mean Harris hip score: post-operative: 60.2 in group I and 66.7 in group ii; last follow-up: 77.4 in group 1 and 83.2 in group II (both p < 0.05)). There were no significant differences in the overall complication rate, including infection, dislocation, re-fracture, and revision surgery, between the two groups. Conclusions Both surgical techniques, cementless long stem and cementless short taper stem with plate osteosynthesis, are effective in the treatment of Vancouver B2 PPFs, with no significant differences in outcomes or complications. However, patients in cementless short taper stem with plate osteosynthesis had better functional scores at both post-operative and the last follow-up.

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Section: Discussionmentioning

confidence: 99%

Long stem revision versus short stem revision with plate osteosynthesis for Vancouver type B2 periprosthetic femoral fracture: a comparative study of eighty five cases

Chen,

Hung,

Liou

et al. 2024

International Orthopaedics (SICOT)

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“…[16][17][18] More recent literature suggests that fracture type as well as stem design, type of fixation, and assessment of the cement (if present) should also have an important influence on the choice of treatment. 12,[19][20][21][22][23][24][25] Outcome measurements in the current literature are often mortality, union rate, time to union, subsidence, and operation-specific outcomes, such as blood loss, time of surgery, and adverse events. 17,21,22,24 There is limited literature concerning patients' functioning and morbidity after PFF, even though this patient group is known to be elderly and frail prior to injury.…”

Section: Introductionmentioning

confidence: 99%

“…12,[19][20][21][22][23][24][25] Outcome measurements in the current literature are often mortality, union rate, time to union, subsidence, and operation-specific outcomes, such as blood loss, time of surgery, and adverse events. 17,21,22,24 There is limited literature concerning patients' functioning and morbidity after PFF, even though this patient group is known to be elderly and frail prior to injury. 9 In observational studies using functional scores such as the Harris Hip Score (HHS) or Oxford Hip Score (OHS), 26,27 poor outcomes have been reported after PFF.…”

Section: Introductionmentioning

confidence: 99%

Health status after periprosthetic proximal femoral fractures

Nieboer,

van der Jagt,

de Munter

et al. 2024

Bone Joint J

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AimsPeriprosthetic proximal femoral fractures (PFFs) are a major complication after total hip arthroplasty (THA). Health status after PFF is not specifically investigated. The aim of this study is to evaluate the health status pattern over two years after sustaining a PFF.MethodsA cohort of patients with PFF after THA was derived from the Brabant Injury Outcomes Surveillance (BIOS) study. The BIOS study, a prospective, observational, multicentre follow-up cohort study, was conducted to obtain data by questionnaires pre-injury and at one week, and one, three, six, 12, and 24 months after trauma. Primary outcome measures were the EuroQol five-dimension three-level questionnaire (EQ-5D-3L), the Health Utility Index 2 (HUI2), and the Health Utility Index 3 (HUI3). Secondary outcome measures were general measurements such as duration of hospital stay and mortality.ResultsA total of 70 patients with a PFF were included. EQ-5D utility scores were significantly lower on all timepoints except at six months’ follow-up compared to pre-injury. EuroQol visual analogue scale (EQ-VAS) scores at one month's follow-up were significantly lower compared to pre-injury. The percentage of reported problems at two years was higher for all dimensions except anxiety/depression when compared to pre-injury. The mean EQ-5D utility score was 0.26 higher in males compared to females (95% confidence interval (CI) 0.01 to 0.42; p = 0.003). The mean EQ-VAS score for males was 8.9 points higher when compared to females over all timepoints (95% CI 1.2 to 16.7; p = 0.027). Mortality was 10% after two years’ follow-up.ConclusionPFF patients are a frail population with substantial functional impairment at baseline. Post-injury, they have a significant and clinically relevant lower health status two years after trauma when compared to pre-injury. Health status improves the most between one and three months after injury. Two years after PFF, more patients experience problems in mobility, self-care, usual activities, and pain/discomfort than pre-injury.Cite this article: Bone Joint J 2024;106-B(5):442–449.

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

Eckardt,

Windischbauer,

Morgenstern

et al. 2024

Arch Orthop Trauma Surg

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Introduction The treatment of Vancouver B2 periprosthetic fractures after hip arthroplasty is still a matter of debate. Revision Arthroplasty (RA) was long thought to be the treatment of choice, however several recent papers suggested that Open Reduction and Internal Fixation (ORIF) is a viable option for selected B2 fractures. Complication rates of 14–26% have been reported following surgical treatment of B2 fractures. No significant difference between RA and ORIF in the complication rates nor in the functional outcome was observed. Method We conducted a retrospective analysis of 97 consecutive Vancouver B2 fractures treated according to the algorithm at our institution from 2007 to 2020 and recorded complications and patient specific data. Result From the 97 patient, 45 fractures were treated with RA while 52 fractures were treated with ORIF. Thirteen patients in the RA group had a complication that needed revision (28%) and 11 patients in the ORIF group needed revision (21%). There was no significant difference between complication rates. The reason for failure in the 13 RA patients were infection (n = 4), stem subsidence (n = 1), refracture after a new fall (n = 3), secondary dislocation of the greater trochanter (n = 1) and dislocation (n = 4). The reason for failure in the 11 ORIF patients that were revised were infection (n = 5), persistent symptomatic stem loosening (n = 3) and refracture (n = 3) after a new fall. Conclusion ORIF can be used to revise cemented and non-cemented shafts in more than half of Vancouver B2 fractures with no difference in complication rates when compared to RA. A periprosthetic fracture around the hip has a 21–28% risk of a re-operation after revision surgery with infection and re-fracture after a new fall being the most frequent cause of re-operation.

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

Cited by 12 publications

References 51 publications

Long stem revision versus short stem revision with plate osteosynthesis for Vancouver type B2 periprosthetic femoral fracture: a comparative study of eighty five cases

Long stem revision versus short stem revision with plate osteosynthesis for Vancouver type B2 periprosthetic femoral fracture: a comparative study of eighty five cases

Health status after periprosthetic proximal femoral fractures

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

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