Treatment of Periprosthetic Femoral Fractures after Total Hip Arthroplasty Vancouver Type B

Abstract

The rate of periprosthetic femoral fractures following total hip replacement has been growing steadily in the last 20 years and ranges from 0.1% to 2.1%. These fractures are mostly related to older patients with the presence of chronic diseases and frequently poor bone quality. The treatment is surgically very complex and demanding, followed by a series of complications. The evaluation in this retrospective study included 23 patients who were medically treated from January 2004 to December 2015 with the mean follow-up of 14.5 (range, 9-25) months. There were 17 patients with cement total hip arthroplasty (THA) and 6 with cementless THA. During treatment of fractures, different techniques were implemented including the use of wire cerclage, dynamic compression plates (DCP), a locking compression plate (LCP) system, and long revision stem. For the purpose of distinguishing fractures, we used the Vancouver classification by Duncan and Masri. For clinical evaluation, we used the modified Merle d'Aubigne score system and monitored complications during treatment. The aim is to show treatment results of the type B periprosthetic femoral fractures by using different operative treatment techniques. According to the Vancouver classification within type B, 10 (43.47%) patients had type B1 fractures, another 10 (43.47%) patients had type B2 fractures, and three (13.04%) patients had type B3 fractures. According to gender distribution, there were eight (34.8%) male and 15 (65.2%) female patients, mean age 59.5 (range, 47-86) years. Twelve (52.2%) and 11 (47.8%) patients had left- and right-sided fractures, respectively. The mean length of hospital stay was 16 (range, 9-26) days. According to the Merle d'Aubigne score system, 10 patients with type B1 fractures had the mean score of 11.5 points, which is poor result. Poor result was also recorded in patients with type B2 fractures, with the mean score of 10.6 points. The three patients with type B3 fractures had the mean score of 12 points, which is considered fair score. In conclusion, Vancouver classification has been widely accepted and using the protocols makes decision making during treatment much easier. During treatment of this type of fracture, we used various implants, wire cerclage, DCP and LCP, as well as long stem revision. In certain cases, we applied surgical techniques, implants that are not recommended by the Vancouver protocol by which we treated periprosthetic femoral fractures; in these case, we recorded nonunion bone, malunion and breaking of implants, which resulted in poor treatment outcome.

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

“…All patients had achieved fracture union by the final follow-up, and the length of femoral stem fixation beyond the distal end of the fracture was greater than 4 cm, which matched well with the femur. The patients in our study achieved better clinical outcomes compared to those in previous studies, 11,33 –37 such as Harris Hip score (Table 5). Further studies with larger sample sizes will be required to determine whether this method will be effective for routine treatment of Vancouver type B2 PFFs.…”

“…Our study involves longer follow-up (102 ± 24.5 months) than most previous studies, which followed up for 14.5–60 months. 11,33 –37 Nevertheless, our study still has several limitations. First, the sample is relatively small, so statistical power is low.…”

Fracture fixation versus revision arthroplasty in Vancouver type B2 and B3 periprosthetic femoral fractures: a systematic review

“…Our systematic search identified 14 original studies that included patients treated with ORIF and patients treated with revision arthroplasty in the treatment of B2 and B3 PFF [5,16,[19][20][21][22][23][24][25][26][27][30][31][32]. The publications were mainly retrospective cohort studies which did not describe the treatment allocation, provided little information about potential predictive factors and presented diverse outcome parameters.…”

“…Eight studies presented information on whether the PFF occurred around primary or around revision hip stems [ 5 , 16 , 22 – 25 , 27 , 31 ], eight presented the information whether the stem was cemented or uncemented [ 5 , 16 , 22 , 24 , 25 , 27 , 30 , 31 ], three provided information about the fixation mechanism of the cemented stem (CCPT or CB) or the stem’s brand name for the respective treatment group [ 16 , 22 , 27 ], three informed about the diagnosis that had led to the initial hip replacement [ 22 , 27 , 31 ] and 7 provided details about the implants used for ORIF [ 16 , 20 , 22 – 25 , 30 ]. One study presented some of the aforementioned parameters for some of the PFF types but did not follow a consistent pattern in doing so [ 26 ].…”

“…Since the reported outcome measures were diverse, it was not possible to summarize them quantitatively. Some studies focused on mobility [ 16 , 23 – 27 , 30 ] as measured with various instruments, whereas other studies focused on union rates [ 16 , 20 , 23 , 24 , 26 , 27 , 32 ], reoperation rates [ 5 , 19 , 21 – 23 , 30 , 32 ], mortality [ 21 , 22 , 25 , 26 ], or on perioperative parameters [ 16 , 19 – 21 , 23 – 25 ], including various combinations of these outcomes.…”