Skip to main content
SpringerLink
Log in

Tapered Fluted Titanium Stems in the Management of Vancouver B2 and B3 Periprosthetic Femoral Fractures

  • Symposium: 2013 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Surgeons have several implant choices when managing Vancouver B2 and B3 periprosthetic fractures about the hip. Few long-term studies have reported outcomes for tapered fluted titanium stems.

Questions/purposes

We determined (1) survival, with femoral revision as the end point, of distal taper stems in the treatment of Vancouver B2 and B3 periprosthetic fractures at our institution, (2) radiographic outcomes, and (3) quality of life and hip function after revision.

Methods

Of the 200 patients with Vancouver B2 or B3 periprosthetic fractures treated with femoral revision between February 2000 and February 2010, 55 (38 B2, 17 B3) were treated with modular tapered titanium stems. Of the surviving 47 patients, one was lost to followup, leaving 46 (30 B2, 16 B3) available for review at a mean of 54 months (range, 24–143 months). Initial indications for using these implants were treatment of periprosthetic fractures where less than 4 cm of diaphyseal fit was available, but this evolved during the study period to all fractures unless no diaphysis remained, in which case complex revision techniques were used. Radiographs were assessed to establish fracture healing, stem subsidence, and bone stock restoration. Quality of life and hip function were assessed using WOMAC, Oxford, SF-12, UCLA activity level, and satisfaction scores.

Results

Two femoral stems were revised: one subsided and was revised at 12 months; the other had deep infection and underwent two-stage revision at 49 months. Radiographic review showed one nonunion, with maintenance or improvement of bone stock in 89% of patients. Subsidence occurred in 24%. Mean Oxford score was 76 of 100, WOMAC function and pain scores were 75 and 82 of 100, satisfaction score was 91 of 100, and SF-12 mental and physical scores were 53 and 40 of 100.

Conclusions

We report encouraging short-term results in terms of survival of distal taper stems in the treatment of B2 and B3 periprosthetic fractures. Although subsidence was frequent, most migrated less than 3 mm without correlation to poor pain and functional scores.

Level of Evidence

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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. 1A–C
Fig. 2A–D
Fig. 3A–C
Fig. 4A–C

Similar content being viewed by others

References

  1. Amstutz HC, Thomas BJ, Jinnah R, Kim W, Grogan T, Yale C. Treatment of primary osteoarthritis of the hip: a comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg Am. 1984;66:228–241.

    CAS  PubMed  Google Scholar 

  2. Australian Orthopaedic Association National Joint Replacement Registry. Annual Report 2010. Adelaide, Australia: AOA; 2010.

  3. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.

    CAS  PubMed  Google Scholar 

  4. Berry DJ. Treatment of Vancouver B3 periprosthetic femur fractures with a fluted tapered stem. Clin Orthop Relat Res. 2003;417:224–231.

    PubMed  Google Scholar 

  5. Biedermann R, Krismer M, Stöckl B, Mayrhofer P, Ornstein E, Franzén H. Accuracy of EBRA-FCA in the measurement of migration of femoral components of total hip replacement. Einzel-Bild-Röntgen-Analyse-femoral component analysis. J Bone Joint Surg Br. 1999;81:266–272.

    Article  CAS  PubMed  Google Scholar 

  6. Böhm P, Bischel O. Femoral revision with the Wagner SL revision stem: evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years. J Bone Joint Surg Am. 2001;83:1023–1031.

    Article  PubMed  Google Scholar 

  7. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91:128–133.

    Article  PubMed  Google Scholar 

  8. Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998;80:63–69.

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  10. Engh CA Jr, McAuley JP, Sychterz CJ, Sacco ME, Engh CA Sr. The accuracy and reproducibility of radiographic assessment of stress-shielding: a postmortem analysis. J Bone Joint Surg Am. 2000;82:1414–1420.

    PubMed  Google Scholar 

  11. Garbuz DS, Toms A, Masri BA, Duncan CP. Improved outcome in femoral revision arthroplasty with tapered fluted modular titanium stems. Clin Orthop Relat Res. 2006;453:199–202.

    Article  PubMed  Google Scholar 

  12. Kwong LM, Miller AJ, Lubinus P. A modular distal fixation option for proximal bone loss in revision total hip arthroplasty: a 2- to 6-year follow-up study. J Arthroplasty. 2003;18:94–97.

    Article  PubMed  Google Scholar 

  13. Mahomed N, Gandhi R, Daltroy L, Katz JN. The self-administered patient satisfaction scale for primary hip and knee arthroplasty. Arthritis. 2011;2011:591253.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Malchau H, Kärrholm J, Wang YX, Herberts P. Accuracy of migration analysis in hip arthroplasty: digitized and conventional radiography, compared to radiostereometry in 51 patients. Acta Orthop Scand. 1995;66:418–424.

    Article  CAS  PubMed  Google Scholar 

  15. McInnis DP, Horne G, Devane PA. Femoral revision with a fluted, tapered, modular stem seventy patients followed for a mean of 3.9 years. J Arthroplasty. 2006;21:372–380.

    Article  PubMed  Google Scholar 

  16. Mulay S, Hassan T, Birtwistle S, Power R. Management of types B2 and B3 femoral periprosthetic fractures by a tapered, fluted, and distally fixed stem. J Arthroplasty. 2005;20:751–756.

    Article  PubMed  Google Scholar 

  17. National Joint Registry for England and Wales. Available at: http://www.njrcentre.org.uk/njrcentre/ Reports,PublicationsandMinutes/Annualreports/tabid/86/Default.aspx. Accessed November 12, 2011.

  18. Neumann D, Thaler C, Dorn U. Management of Vancouver B2 and B3 femoral periprosthetic fractures using a modular cementless stem without allografting. Int Orthop. 2012;36:1045–1050.

    Article  PubMed Central  PubMed  Google Scholar 

  19. New Zealand Joint Registry. Eleven Year Report. Christchurch, New Zealand: NZOA; 2010.

  20. O’Shea K, Quinlan JF, Kutty S, Mulcahy D, Brady OH. The use of uncemented extensively porous-coated femoral components in the management of Vancouver B2 and B3 periprosthetic femoral fractures. J Bone Joint Surg Br. 2005;87:1617–1621.

    Article  PubMed  Google Scholar 

  21. Ovesen O, Emmeluth C, Hofbauer C, Overgaard S. Revision total hip arthroplasty using a modular tapered stem with distal fixation: good short-term results in 125 revisions. J Arthroplasty. 2010;25:348–354.

    Article  PubMed  Google Scholar 

  22. Park MS, Lim YJ, Chung WC, Ham DH, Lee SH. Management of periprosthetic femur fractures treated with distal fixation using a modular femoral stem using an anterolateral approach. J Arthroplasty. 2009;24:1270–1276.

    Article  PubMed  Google Scholar 

  23. Park YS, Moon YW, Lim SJ. Revision total hip arthroplasty using a fluted and tapered modular distal fixation stem with and without extended trochanteric osteotomy. J Arthroplasty. 2007;22:993–999.

    Article  PubMed  Google Scholar 

  24. Richards CJ, Duncan CP, Masri BA, Garbuz DS. Femoral revision hip arthroplasty: a comparison of two stem designs. Clin Orthop Relat Res. 2010;468:491–496.

    Article  PubMed  Google Scholar 

  25. Rodriguez JA, Deshmukh AJ, Klauser WU, Rasquinha VJ, Lubinus P, Ranawat CS. Patterns of osseointegration and remodeling in femoral revision with bone loss using modular, tapered, fluted, titanium stems. J Arthroplasty. 2011;26:1409–1417.

    Article  PubMed  Google Scholar 

  26. Sporer SM, Paprosky WG. Femoral fixation in the face of considerable bone loss: the use of modular stems. Clin Orthop Relat Res. 2004;429:227–231.

    Article  PubMed  Google Scholar 

  27. Springer BD, Berry DJ, Lewallen DG. Treatment of periprosthetic femoral fractures following total hip arthroplasty with femoral component revision. J Bone Joint Surg Am. 2003;85:2156–2162.

    PubMed  Google Scholar 

  28. Van Houwelingen AP, Duncan CP, Masri BA, Greidanus NV, Garbuz DS. High survival of modular tapered stems for proximal femoral bone defects at 5 to 10 years followup. Clin Orthop Relat Res. 2013;471:454–462.

    Article  PubMed  Google Scholar 

  29. Wagner H. Revision prosthesis for the hip joint in severe bone loss. Orthopade. 1987;16:295–300.

    CAS  PubMed  Google Scholar 

  30. Wagner H. A revision prosthesis for the hip joint. Orthopade. 1989;18:438–453.

    CAS  PubMed  Google Scholar 

  31. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233.

    Article  PubMed  Google Scholar 

  32. Weiss RJ, Beckman MO, Enocson A, Schmalholz A, Stark A. Minimum 5-year follow-up of a cementless, modular, tapered stem in hip revision arthroplasty. J Arthroplasty. 2011;26:16–23.

    Article  PubMed  Google Scholar 

  33. Wright JM, Pellicci PM, Salvati EA, Ghelman B, Roberts MM, Koh JL. Bone density adjacent to press-fit acetabular components: a prospective analysis with quantitative computed tomography. J Bone Joint Surg Am. 2001;83:529–536.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Eric Sayre PhD for his assistance with the statistical analysis and Daphné Savoy BA for her assistance in the preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of British Columbia, 910 West 10th Avenue, Room 3114, Vancouver, BC, V5Z 4E3, Canada

    Jacob T. Munro MBChB, Donald S. Garbuz MD, MHSc, Bassam A. Masri MD & Clive P. Duncan MD, MSc

Authors
  1. Jacob T. Munro MBChB
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donald S. Garbuz MD, MHSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bassam A. Masri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Clive P. Duncan MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bassam A. Masri MD.

Additional information

The institution of the authors has received, during the study period, funding from Zimmer, Inc (Warsaw, IN, USA), DePuy Synthes Canada Ltd (Markham, ON, Canada), Johnson & Johnson (Canada) Inc (Markham, ON, Canada), Stryker Canada (Hamilton, ON, Canada), and Bayer Inc (Toronto, ON, Canada). One or more of the authors certify that they have received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000, from Zimmer, Inc (JTM, DSG, BAM, CPD), and an amount of USD 10,000 to USD 100,000, from DePuy Synthes Canada Ltd (JTM, CPD).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Munro, J.T., Garbuz, D.S., Masri, B.A. et al. Tapered Fluted Titanium Stems in the Management of Vancouver B2 and B3 Periprosthetic Femoral Fractures. Clin Orthop Relat Res 472, 590–598 (2014). https://doi.org/10.1007/s11999-013-3087-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-013-3087-3

Keywords

Search

Navigation