Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 23;23(1):280.
doi: 10.1186/s12891-022-05240-w.

The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) - a systematic review

Clemens Schopper  1 , Matthias Luger  2 , Günter Hipmair  1 , Bernhard Schauer  1 , Tobias Gotterbarm  1 , Antonio Klasan  1
Affiliations

The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) - a systematic review

Clemens Schopper et al. BMC Musculoskelet Disord. .

Abstract

Background: Periprosthetic femoral fractures (PFFs) represent a major cause for surgical revision after hip arthroplasty with detrimental consequences for patients. The Vancouver classification has been traditionally used since its introduction in 1995. The Unified Classification System (UCS) was described in 2014, to widen the spectrum by aiming for a more comprehensive approach. The UCS also aimed to replace the Vancouver classification by expanding the idea of the Vancouver classification to the whole musculoskeletal apparatus. After introduction of the UCS, the question was raised, whether the UCS found its place in the field of analysing PFFs. Therefore, this systematic review was performed to investigate, the use of the UCS compared to the established Vancouver classification.

Methods: Medline was searched for reports published between 1 January 2016 and 31 November 2020, without language restriction. Included were original articles, irrespective of the level of evidence and case reports reporting on a PFF and using either the Vancouver or the UCS to classify the fractures. Excluded were reviews and systematic reviews.

Results: One hundred forty-six studies were included in the analysis. UCS has not been used in a single registry study, giving a pooled cohort size of 3299 patients, compared to 59,178 patients in studies using the Vancouver classification. Since 2016, one study using UCS was published in a top journal, compared to 37 studies using the Vancouver classification (p=0.29). During the study period, the number of yearly publications remained stagnant (p=0.899).

Conclusions: Despite valuable improvement and expansion of the latter UCS, to date, the Vancouver system clearly leads the field of classifying PFFs in the sense of the common use.

Keywords: Periprosthetic fractures; UCS; Unified Classification System; Vancouver classification.

PubMed Disclaimer

Conflict of interest statement

Clemens Schopper: No conflict of interest/no competing interest.

Matthias Luger: No conflict of interest/no competing interest.

Günter Hipmair: Consultant honoraria of ZimmerBiomet, Europe, outside the submitted work.

Bernhard Schauer: No conflict of interest/no competing interest.

Tobias Gotterbarm: Personal fees paid during the conduct of the study from Zimmer Biomet, Europe and from Depuy Synthes Orthopädie Gmbh, Peter Brehm GmbH, ImplanTec GmbH outside the submitted work.

Antonio Klasan: No financial conflict of interest; Associated editor of the BMC Musculoskeletal Disorders journal.

Additionally, we report research grants paid to our institution during the conduct of the study from Zimmer Biomet, Europe, Mathys AG Switzerland, Anika Therapeutics outside the submitted work.

Figures

Fig. 1
Fig. 1
Consort diagram
Fig. 2
Fig. 2
Comparison of yearly publications with Vancouver and Unified Classification between 2016 and 2020
See this image and copyright information in PMC

References

    1. De Meo D, Zucchi B, Castagna V, Pieracci EM, Mangone M, Calistri A, Persiani P, Villani C. Validity and reliability of the Unified Classification System applied to periprosthetic femur fractures: a comparison with the Vancouver system. Curr Med Res Opin. 2020;36(8):1375–1381. - PubMed
    1. Capone A, Congia S, Civinini R, Marongiu G. Periprosthetic fractures: epidemiology and current treatment. Clin Cases Miner Bone Metab. 2017;14(2):189–196. - PMC - PubMed
    1. Huang JF, Jiang XJ, Shen JJ, Zhong Y, Tong PJ, Fan XH. Modification of the Unified Classification System for periprosthetic femoral fractures after hip arthroplasty. J Orthop Sci. 2018;23(6):982–986. - PubMed
    1. Abdel MP, Watts CD, Houdek MT, Lewallen DG, Berry DJ. Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Joint J. 2016;98-B(4):461–467. - PubMed
    1. Haddad FS, Duncan CP, Berry DJ, Lewallen DG, Gross AE, Chandler HP. Periprosthetic femoral fractures around well-fixed implants: use of cortical onlay allografts with or without a plate. J Bone Joint Surg Am. 2002;84(6):945–950. - PubMed

Publication types

MeSH terms