Skip to main content

Advertisement

SpringerLink
Log in

Comparative study of Vancouver type B2 periprosthetic fractures treated by internal fixation versus stem revision

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Currently, accepted treatment for periprosthetic femoral fractures with loose femoral stem indicates its revision; however, recent studies have proposed treating Vancouver type B2 fractures via internal fixation without stem revision, particularly in the elderly or multi-morbid patients. Despite indications for stem revision, some surgeons tend to perform internal fixation. The main goal of this study was therefore to identify the parameters that were significantly different comparing internal fixation to stem revision for Vancouver type B2 fractures.

Methods

Eighty-one Vancouver B2 periprosthetic femoral fractures, treated between 2010 and 2019, were analysed. The internal fixation (ORIF) and the revision groups were compared. Patients’ age, BMI, American Society of Anaesthesiologists (ASA) score, anaesthesia type, operating time, blood loss, surgeons’ experience, post-operative weight-bearing, length of hospital stay, and radiological outcome using AGORA roentgenographic assessment were analysed.

Results

Patients chosen for ORIF were significantly older than those treated by stem revision (85.4 vs 75.1 years; p = 0.002). Blood loss was 390.7 and 1141.6 ml in the ORIF and revision groups, respectively (p < 0.0001). The surgical times were 134.5 and 225 min in the ORIF and revision groups, respectively (p < 0.0001). Our analysis of BMI, ASA score, anaesthesia type, length of hospital stay, surgeons’ experience and radiological outcome, were not significantly different between the two groups.

Conclusion

Revision did not exhibit better radiological results; moreover, internal fixation resulted in significantly less perioperative blood loss and a shorter operating time, concluding that ORIF is a viable alternative to revision arthroplasty, particularly in older patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

Data available on request from the author.

References

  1. Learmonth ID (2004) The management of periprosthetic fractures around the femoral stem. J Bone Jt Surg Br 86:13–19

    Article  CAS  Google Scholar 

  2. Antoci V, Appleton P, Rodriguez EK (2014) Fixation of fractures around unstable hip implants. Tech Orthop 29:200–209. https://doi.org/10.1097/BTO.0000000000000102

    Article  Google Scholar 

  3. Lindahl H (2007) Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury 38:651–654. https://doi.org/10.1016/j.injury.2007.02.048

    Article  PubMed  Google Scholar 

  4. Delgado A, Cordero G-GE, Marcos S, Cordero-Ampuero J (2020) Influence of cognitive impairment on mortality, complications and functional outcome after hip fracture: dementia as a risk factor for sepsis and urinary infection. Injury 51(Suppl1):S19–S24. https://doi.org/10.1016/j.injury.2020.02.009

    Article  PubMed  Google Scholar 

  5. Pike J, Davidson D, Garbuz D, Duncan CP, O’Brien PJ, Masri BA (2009) Principles of treatment for periprosthetic femoral shaft fractures around well-fixed total hip arthroplasty. J Am Acad Orthop Surg 17:677–688. https://doi.org/10.5435/00124635-200911000-00002

    Article  PubMed  Google Scholar 

  6. Chatziagorou G, Lindahl H, Garellick G, Kärrholm J (2019) Incidence and demographics of 1751 surgically treated periprosthetic femoral fractures around a primary hip prosthesis. Hip Int 29:282–288. https://doi.org/10.1177/1120700018779558

    Article  PubMed  Google Scholar 

  7. Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304

    CAS  PubMed  Google Scholar 

  8. Gaski GE, Scully SP (2011) In brief: classifications in brief: Vancouver classification of postoperative periprosthetic femur fractures. Clin Orthop Relat Res 469:1507–1510. https://doi.org/10.1007/s11999-010-1532-0

    Article  PubMed  Google Scholar 

  9. Naqvi GA, Baig SA, Awan N (2012) Interobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty. J Arthroplasty 27:1047–1050. https://doi.org/10.1016/j.arth.2011.11.021

    Article  PubMed  Google Scholar 

  10. Rayan F, Haddad F (2010) Periprosthetic femoral fractures in total hip arthroplasty—a review. Hip Int 20:418–426. https://doi.org/10.1177/112070001002000402

    Article  PubMed  Google Scholar 

  11. Schwarzkopf R, Oni JK (2013) Marwin SE (2013) Total hip arthroplasty periprosthetic femoral fractures: a review of classification and current treatment. Bull Hosp Jt Dis 71:68–78

    Google Scholar 

  12. Sledge JB 3rd, Abiri A (2002) An algorithm for the treatment of Vancouver type B2 periprosthetic proximal femoral fractures. J Arthroplasty 17:887–892. https://doi.org/10.1054/arth.2002.34810

    Article  PubMed  Google Scholar 

  13. Niikura T, Lee SY, Sakai Y, Nishida K, Kuroda R, Kurosaka M (2014) Treatment results of a periprosthetic femoral fracture case series: treatment method for Vancouver type b2 fractures can be customized. Clin Orthop Surg 6:138–145. https://doi.org/10.4055/cios.2014.6.2.138

    Article  PubMed  PubMed Central  Google Scholar 

  14. Solomon LB, Hussenbocus SM, Carbone TA, Callary SA, Howie DW (2015) Is internal fixation alone advantageous in selected B2 periprosthetic fractures? ANZ J Surg 85:169–173. https://doi.org/10.1111/ans.12884

    Article  PubMed  Google Scholar 

  15. Stoffel K, Blauth M, Joeris A, Blumenthal A, Rometsch E (2020) Fracture fixation versus revision arthroplasty in Vancouver type B2 and B3 periprosthetic femoral fractures: a systematic review. Arch Orthop Trauma Surg 140:1381–1394. https://doi.org/10.1007/s00402-020-03332-7

    Article  PubMed  PubMed Central  Google Scholar 

  16. Epinette JA, Geesink RGT (1995) Radiographic assessment of cementless hip prostheses: ARA, a proposed new scoring system. Exp Sci Fr (English Volume)

  17. Epinette JA (1999) Radiographic assessment of cementless hip prostheses: the “ARA” scoring system. Eur J Orthop Surg Traumatol 9:91–94. https://doi.org/10.1007/BF01695736

    Article  Google Scholar 

  18. The SoFCOT Group, Delaunay C, Hamadouche M, Girard J, Duhamel A (2013) What are the causes for failures of primary hip arthroplasties in France? Clin Orthop Relat Res 471:3863–3869. https://doi.org/10.1007/s11999-013-2935-5

    Article  PubMed Central  Google Scholar 

  19. Joestl J, Hofbauer M, Lang N, Tiefenboeck T, Hajdu S (2016) Locking compression plate versus revision-prosthesis for Vancouver type B2 periprosthetic femoral fractures after total hip arthroplasty. Injury 47:939–943. https://doi.org/10.1016/j.injury.2016.01.036

    Article  PubMed  Google Scholar 

  20. Manara J, Sandhu H, Wee M et al (2020) Prolonged operative time increases risk of blood loss and transfusion requirements in revision hip surgery. Eur J Orthop Surg Traumatol 30:1181–1186. https://doi.org/10.1007/s00590-020-02677-4

    Article  PubMed  Google Scholar 

  21. Ricci WM (2015) Periprosthetic femur fractures. J Orthop Trauma 29:130–137. https://doi.org/10.1097/BOT.0000000000000282

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Special thanks to Ms. Agnes Stoka for substantial help in creation of this article. We also would like to thank Editage.com for English language editing.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Brugmann University Hospital, Free University of Brussels, Place Van Gehuchten 4, 1020, Brussels, Belgium

    Sagi Martinov, Sebastien D’ulisse, Edouard Haumont, Dragos Schiopu, Pieter Reynders & Tamás Illés

  2. Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada

    Sagi Martinov

  3. Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark

    Tamás Illés

  4. National Medical Academy, Paris, France

    Tamás Illés

Authors
  1. Sagi Martinov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastien D’ulisse
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Edouard Haumont
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dragos Schiopu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pieter Reynders
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tamás Illés
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sagi Martinov.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare relevant to the content of this article.

Ethical approval

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Ethics Committee of Free University of Brussels approved this study.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Patients signed informed consent regarding publishing their data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martinov, S., D’ulisse, S., Haumont, E. et al. Comparative study of Vancouver type B2 periprosthetic fractures treated by internal fixation versus stem revision. Arch Orthop Trauma Surg 142, 3589–3597 (2022). https://doi.org/10.1007/s00402-021-03953-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-021-03953-6

Keywords

Search

Navigation