Skip to main content

Advertisement

Log in

Principles of managing Vancouver type B periprosthetic fractures around cemented polished tapered femoral stems

  • General Review • HIP - ARTHROPLASTY
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

The management of periprosthetic fractures around total hip replacements is a complex and challenging problem. Getting it right first time is an important factor in reducing the morbidity, mortality and financial burden associated with these injuries. Understanding and applying the basic principles of fracture management helps increase the chance of successful treatment. Based on these principles, we suggest a treatment algorithm for managing periprosthetic fractures around polished tapered femoral stems.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Phillips JR, Boulton C, Morac CG, Manktelov AR (2011) What is the financial cost of treating periprosthetic hip fractures? Injury 42(2):146–149

    Article  CAS  PubMed  Google Scholar 

  2. Jones AR, Williams T, Paringe V, White SP (2016) The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study. Injury 47(2):428–431

    Article  PubMed  Google Scholar 

  3. Abdel MP, Watts CD, Houdek MT, Lewallen DG, Berry DJ (2016) Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Joint J 98-B(4):461–467

    Article  CAS  PubMed  Google Scholar 

  4. National Joint Registry for England and Wales: 11th Annual Report 2014. http://www.njrcentre.org.uk/njrcentre/Reports,PublicationsandMinutes/Annualreports/tabid/86/Default.aspx

  5. National Joint Registry for England and Wales: 3rd Annual Report 2006. http://www.njrcentre.org.uk/njrcentre/Reports,PublicationsandMinutes/Annualreports/Archivedannualreports/tabid/87/Default.aspx

  6. Zuurmond RG, van Wijhe W, van Raay JJ, Bulstra SK (2010) High incidence of complications and poor clinical outcome in the operative treatment of periprosthetic femoral fractures: an analysis of 71 cases. Injury 41(6):629–633

    Article  CAS  PubMed  Google Scholar 

  7. Franklin J, Malchau H (2007) Risk factors for periprosthetic femoral fracture. Injury 38(6):655–660

    Article  PubMed  Google Scholar 

  8. Griffiths EJ, Cash DJ, Kalra S, Hopgood PJ (2013) Time to surgery and 30-day morbidity and mortality of periprosthetic hip fractures. Injury 44(12):1949–1952

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  10. Duncan CP, Haddad FS (2014) The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J 96-B(6):713–716

    Article  CAS  PubMed  Google Scholar 

  11. Sledge JB 3rd, Abiri A (2002) An algorithm for the treatment of Vancouver type B2 periprosthetic proximal femoral fractures. J Arthroplasty 17(7):887–892

    Article  PubMed  Google Scholar 

  12. Parvizi J, Rapuri VR, Purtill JJ, Sharkey PF, Rothman RH, Hozack WJ (2004) Treatment protocol for proximal femoral periprosthetic fractures. J Bone Joint Surg Am 86-A(Suppl 2):8–16

    Article  Google Scholar 

  13. Laing PG (1953) The blood supply of the femoral shaft; an anatomical study. J Bone Joint Surg Br 35-B(3):462–466

    CAS  PubMed  Google Scholar 

  14. Schemitsch EH, Kowalski MJ, Swiontkowski MF, Senft D (1994) Cortical bone blood flow in reamed and unreamed locked intramedullary nailing: a fractured tibia model in sheep. J Orthop Trauma 8(5):373–382

    Article  CAS  PubMed  Google Scholar 

  15. VanEnkevort BA, Markel MD, Manley PA (1999) Alterations in bone remodeling in the femur after medullary reaming and cemented hip arthroplasty in dogs. Am J Vet Res 60(8):922–928

    CAS  PubMed  Google Scholar 

  16. Hupel TM, Schemitsch EH, Aksenov SA, Waddell JP (2000) Blood flow changes to the proximal femur during total hip arthroplasty. Can J Surg 43(5):359–364

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Syed KA, Kuzyk PR, Yoo DJ, Zdero R, Richards RR, Schemitsch EH (2013) Changes in femoral cortical porosity after reaming and intramedullary canal preparation in a canine model. J Arthroplasty 28(2):368–373

    Article  PubMed  Google Scholar 

  18. ElMaraghy AW, Humeniuk B, Anderson GI, Schemitsch EH, Richards RR (1999) Femoral bone blood flow after reaming and intramedullary canal preparation: a canine study using laser Doppler flowmetry. J Arthroplasty 14(2):220–226

    Article  CAS  PubMed  Google Scholar 

  19. Mirza SB, Dunlop DG, Panesar SS, Naqvi SG, Gangoo S, Salih S (2010) Basic science considerations in primary total hip replacement arthroplasty. Open Orthop J 4:169–180

    Article  PubMed  PubMed Central  Google Scholar 

  20. Perren SM, Fernandez Dell’Oca A, Lenz M, Windolf M (2011) Cerclage, evolution and potential of a Cinderella technology. An overview with reference to periprosthetic fractures. Acta Chir Orthop Traumatol Cech 78(3):190–199

    CAS  PubMed  Google Scholar 

  21. Shen G (1998) Femoral stem fixation. An engineering interpretation of the long-term outcome of Charnley and Exeter stems. J Bone Joint Surg Br 80(5):754–756

    Article  CAS  PubMed  Google Scholar 

  22. Phillips J, Boulton C, Moran C, Manktelow A (2012) Periprosthetic fractures around exeter stems: a new injury? JBJS (Br) 94-B(SUPP XXV):187

    Google Scholar 

  23. Ohly NE, Whitehouse MR, Duncan CP (2014) Periprosthetic femoral fractures in total hip arthroplasty. Hip Int 24(6):556–567

    Article  PubMed  Google Scholar 

  24. Briant-Evans TW, Veeramootoo D, Tsiridis E, Hubble MJ (2009) Cement-in-cement stem revision for Vancouver type B periprosthetic femoral fractures after total hip arthroplasty. A 3-year follow-up of 23 cases. Acta Orthop 80(5):548–552

    Article  PubMed  PubMed Central  Google Scholar 

  25. Corten K, Vanrykel F, Bellemans J, Frederix PR, Simon JP, Broos PL (2009) An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component. J Bone Joint Surg Br 91(11):1424–1430

    Article  CAS  PubMed  Google Scholar 

  26. Schmotzer H, Tchejeyan GH, Dall DM (1996) Surgical management of intra- and postoperative fractures of the femur about the tip of the stem in total hip arthroplasty. J Arthroplasty 11(6):709–717

    Article  CAS  PubMed  Google Scholar 

  27. 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):523–528

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Conal Quah.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Quah, C., Porteous, M. & Stephen, A. Principles of managing Vancouver type B periprosthetic fractures around cemented polished tapered femoral stems. Eur J Orthop Surg Traumatol 27, 477–482 (2017). https://doi.org/10.1007/s00590-016-1883-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-016-1883-7

Keywords

Navigation