Vancouver B2 periprosthetic femoral fractures: a comparative study of stem revision versus internal fixation with plate

  • Mauro Spina
  • Andrea Scalvi
Original Article • HIP - ARTHROPLASTY



The aim is to compare stem revision versus internal fixation with plate in the treatment of Vancouver B2 periprosthetic femoral fractures.

Materials and methods

This is a retrospective review of 34 consecutive patients admitted from June 1998 to May 2017. One patient was treated conservatively, 11 with stem revision (group 1), 20 with plate, screws and cerclage (group 2), one patient with cerclage alone and another by Girdlestone procedure. We assessed surgical complications, mortality within 1 year, functional outcome with Harris Hip Score and radiographic outcome with Beals and Tower’s criteria.


At an average follow-up of 30.1 months in group 1, we had 36.4% of patients with complications, HHS of 66.8, radiographic outcome “excellent-good” in 91% of cases. In group 2 we had 25% of patients with complications, HHS of 71.8, radiographic outcome “excellent-good” in 80% of cases. There were no significant differences in 1-year mortality between the two groups. In group 2, the best outcomes were obtained in uncemented straight stems with Johansson type 1 fracture and in cemented polished stems with stem detachment from the cement–bone complex. Whatever treatment was adopted, there was an overall worsening in quality of life.


Stem revision remains the treatment of choice in Vancouver B2 fractures, but, in selected cases, internal fixation with plate, screws and cerclage can be a viable alternative option.


Periprosthetic fracture Vancouver B2 Internal fixation Revision stem 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304PubMedGoogle Scholar
  2. 2.
    Lindahl H, Malchau H, Herberts P, Garellick G (2005) Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 20(7):857–865CrossRefPubMedGoogle Scholar
  3. 3.
    Marshall RA, Weaver MJ, Sodickson A, Khurana B (2017) Periprosthetic femoral fractures in the emergency department: what the orthopedic surgeon wants to know. Radiographics 37(4):1202–1217CrossRefPubMedGoogle Scholar
  4. 4.
    Beals RK, Tower SS (1996) Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res 327:238–246CrossRefGoogle Scholar
  5. 5.
    Lindahl H, Malchau H, Odén A, Garellick G (2006) Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br 88(1):26–30CrossRefPubMedGoogle Scholar
  6. 6.
    Dennis MG, Simon JA, Kummer FJ, Koval KJ, DiCesare PE (2000) Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques. J Arthroplasty 15(4):523–528CrossRefPubMedGoogle Scholar
  7. 7.
    Katzer A, Ince A, Wodtke J, Loehr JF (2006) Component exchange in treatment of periprosthetic femoral fractures. J Arthroplasty 21(4):572–579CrossRefPubMedGoogle Scholar
  8. 8.
    Masri BA, Meek RM, Duncan CP (2004) Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 420:80–95CrossRefGoogle Scholar
  9. 9.
    Young SW, Walker CG, Pitto RP (2008) Functional outcome of femoral peri prosthetic fracture and revision hip arthroplasty: a matched-pair study from the New Zealand Registry. Acta Orthop 79(4):483–488CrossRefPubMedGoogle Scholar
  10. 10.
    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(4):939–943CrossRefPubMedGoogle Scholar
  11. 11.
    Christophe A, Troussel S, Detrembleur C, Putineanu D (2017) Surgery of Vancouver type B2 periprosthetic femoral fracture after total hip arthroplasty in elderly patients: an alternative way with internal fixation. SM Gerontol Geriatr Res 1(2):1006Google Scholar
  12. 12.
    Brady OH, Garbuz DS, Masri BA, Duncan CP (2000) The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty 15(1):59–62CrossRefPubMedGoogle Scholar
  13. 13.
    Johansson JE, McBroom R, Barrington TW, Hunter GA (1981) Fracture of the ipsilateral femur in patients with total hip replacement. J Bone Joint Surg Am 63(9):1435–1442CrossRefPubMedGoogle Scholar
  14. 14.
    Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51(4):737–755CrossRefPubMedGoogle Scholar
  15. 15.
    Tower SS, Beals RK (1999) Fractures of the femur after hip replacement: the Oregon experience. Orthop Clin N Am 30(2):235–247CrossRefGoogle Scholar
  16. 16.
    Khan T, Grindlay D, Ollivere BJ, Scammell BE, Manktelow AR, Pearson RG (2017) A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Joint J 99-B(4 Supple B):17–25CrossRefPubMedGoogle Scholar
  17. 17.
    Ko PS, Lam JJ, Tio MK, Lee OB, Ip FK (2003) Distal fixation with Wagner revision stem in treating Vancouver type B2 periprosthetic femur fractures in geriatric patients. J Arthroplasty 18(4):446–452CrossRefPubMedGoogle Scholar
  18. 18.
    Marx A, Beier A, Jung L, Lohmann CH, Halder AM (2012) Peri-prosthetic femoral fractures treated with the uncemented Wagner revision stem. Hip Int 22(3):286–291CrossRefPubMedGoogle Scholar
  19. 19.
    Haasper C, Enayatollahi MA, Gehrke T (2015) Treatment of Vancouver type B2 periprosthetic femoral fractures. Int Orthop 39(10):1989–1993CrossRefPubMedGoogle Scholar
  20. 20.
    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(3):169–173CrossRefPubMedGoogle Scholar
  21. 21.
    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(2):138–145CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Mulay S, Hassan T, Birtwistle S, Power R (2005) Management of types B2 and B3 femoral periprosthetic fractures by a tapered, fluted, and distally fixed stem. J Arthroplasty 20(6):751–756CrossRefPubMedGoogle Scholar
  23. 23.
    Gitajn IL, Heng M, Weaver MJ, Casemyr N, May C, Vrahas MS, Harris MB (2017) Mortality following surgical management of Vancouver B periprosthetic fractures. J Orthop Trauma 31(1):9–14CrossRefPubMedGoogle Scholar
  24. 24.
    de Boer FA, Sariali E (2017) Comparison of anatomic vs. straight femoral stem design in total hip replacement—femoral canal fill in vivo. Hip Int 27(3):241–244CrossRefPubMedGoogle Scholar
  25. 25.
    Timperley AJ, Gie GA, Lee AJ, Ling RS (1993) The femoral component as a taper in cemented total hip arthroplasty. J Bone Joint Surg Br 75(Suppl I):33Google Scholar
  26. 26.
    Moreta J, Aguirre U, de Ugarte OS, Jáuregui I, Mozos JL (2015) Functional and radiological outcome of periprosthetic femoral fractures after hip arthroplasty. Injury 46(2):292–298CrossRefPubMedGoogle Scholar
  27. 27.
    Canbora K, Kose O, Polat A, Aykanat F, Gorgec M (2013) Management of Vancouver type B2 and B3 femoral periprosthetic fractures using an uncemented extensively porous-coated long femoral stem prosthesis. Eur J Orthop Surg Traumatol 23(5):545–552CrossRefPubMedGoogle Scholar
  28. 28.
    Neumann D, Thaler C, Dorn U (2012) Management of Vancouver B2 and B3 femoral periprosthetic fractures using a modular cementless stem without allografting. Int Orthop 36(5):1045–1050CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopedics and TraumatologyAzienda Ospedaliero Universitaria Integrata of VeronaVeronaItaly

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