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. 2022:8:1.
doi: 10.1051/sicotj/2021064. Epub 2022 Jan 6.

The impact of stem fixation method on Vancouver Type B1 periprosthetic femoral fracture management

Katherine Wang  1 , Eustathios Kenanidis  2 , Zakareya Gamie  3 , Khurram Suleman  1 , Mark Miodownik  1 , Mahsa Avadi  4 , David Horne  4 , Jonathan Thompson  4 , Eleftherios Tsiridis  2 , Mehran Moazen  1
Affiliations

The impact of stem fixation method on Vancouver Type B1 periprosthetic femoral fracture management

Katherine Wang et al. SICOT J. 2022.

Abstract

Introduction: Our understanding of the impact of the stem fixation method in total hip arthroplasty (THA) on the subsequent management of periprosthetic femoral fractures (PFF) is still limited. This study aimed to investigate and quantify the effect of the stem fixation method, i.e., cemented vs. uncemented THA, on the management of Vancouver Type B1 periprosthetic femoral fractures with the same plate.

Methods: Eight laboratory models of synthetic femora were divided into two groups and implanted with either a cemented or uncemented hip prosthesis. The overall stiffness and strain distribution were measured under an anatomical one-legged stance. All eight specimens underwent an osteotomy to simulate Vancouver type B1 PFF's. Fractures were then fixed using the same extramedullary plate and screws. The same measurements and fracture movement were taken under the same loading conditions.

Results: Highlighted that the uncemented THA and PFF fixation constructs had a lower overall stiffness. Subsequently, the mechanical strain on the fracture plate for the uncemented construct was higher compared to the cemented constructs.

Conclusion: PFF fixation of a Vancouver type B1 fracture using a plate may have a higher risk of failure in uncemented THAs.

Keywords: Biomechanics; Cemented; Periprosthetic femoral fracture (PFF); Total hip arthroplasty (THA); Uncemented.

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Figures

Figure 1
Figure 1
Overview of the study. Experimental setup of total hip replacement (A) and periprosthetic femoral fracture fixation (B). S1–S2 highlight strain gauge attachment site on the stem, B1–B5 highlight strain gauge attachment site on the bone, and P1–P3 highlight strain gauge attachment site on the fracture plate.
Figure 2
Figure 2
Comparison of stiffness between Cemented and Uncemented specimens based on the overall average in THA group (A) and PFF group (B). *denotes statistical difference between the two variables (P < 0.05).
Figure 3
Figure 3
Summary of the strain measurements taken from strain gauges on different locations of the construct under a 500 N axial load in THA cemented vs. uncemented constructs (A) and in cemented and uncemented PFF fixation constructs (B). *Highlights statistical difference between corresponding groups (P < 0.05).
Figure 4
Figure 4
Comparison between the pattern of minimum principal strain across the medial side of the bone, between the uncemented and cemented group at 500 N axial load.
Figure 5
Figure 5
Comparison between the pattern of maximum principal strain across the fracture plate at site of fracture, between the uncemented and cemented group at 500 N axial load.
Figure 6
Figure 6
Fracture movement data for cemented and uncemented constructs. Measurements were taken at the fracture site on the medial side of the construct.
See this image and copyright information in PMC

References

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