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
Comparative Study
. 2024 May;34(4):2055-2063.
doi: 10.1007/s00590-024-03881-2. Epub 2024 Mar 25.

Vancouver B2 periprosthetic hip fractures treatment: fix or replace? A retrospective study comparing both techniques

Yuri Lara-Taranchenko  1 , Josep F Nomdedéu Jr  2 , Víctor M Barro  2 , José V Andrés Peiró  2 , Ernesto Guerra-Farfán  2 , Jordi Selga  2 , Jordi Tomás-Hernández  2 , Jordi Teixidor Serra  2 , Vicente Molero  2 , Diego Collado  2 , Iñaki Mimendia  2 , Alejandro Hernández  2 , Juan A Porcel-Vázquez  3
Affiliations
Comparative Study

Vancouver B2 periprosthetic hip fractures treatment: fix or replace? A retrospective study comparing both techniques

Yuri Lara-Taranchenko et al. Eur J Orthop Surg Traumatol. 2024 May.

Abstract

Introduction: Vancouver B2 periprosthetic hip fractures involve stem stability and they have been classically treated with revision surgery. Crucial factors such as age, clinical comorbidities and functional status are often neglected. The current study aims to compare clinical outcomes between patients treated with open reduction and internal fixation (ORIF) or femoral stem exchange.

Methods: This is a retrospective study that includes all Vancouver B2 periprosthetic hip fractures in a tertiary referral hospital from 2016 to 2020. Patients were divided into two groups: Group 1. Patients treated with an ORIF and Group 2. Patients treated with stem replacement. The outcomes that were compared between groups included demographic data, functional capacity, complications and mortality.

Results: 29 periprosthetic Vancouver B2 fractures were finally analyzed. 11 (37.9%) were treated with ORIF (Group 1) and 18 (62.1%) by stem replacement (Group 2). Surgery time (143 vs. 160 min), hemoglobin drop (1.8 vs. 2.5 g/dL) and hospital stance (25.5 vs. 29.6 days) were shorter in Group 1. According to complications, 18.2% of patients in the ORIF group had orthopedic complications compared with 44.4% in the revision group. In the revision group, 3 cases needed a two-stage revision and one of these revisions ended up with a resection arthroplasty (Girdlestone). The first-year mortality rate was 27% in Group 1 and 11% in Group 2.

Discussion: ORIF treatment seems to be a less aggressive and complex procedure which can lead to a faster general recovery. Revision surgery can imply a higher risk of orthopedic complications which can be severe and may require further aggressive solutions. The ORIF group mortality was similar to the proximal femur fracture rate (20-30%). In conclusion, ORIF treatment seems to be a good option especially in fragile patients with low functional demand when anatomical reduction is possible.

Keywords: Fixation; Fracture; Hip; Periprosthetic; Revision; Vancouver.

PubMed Disclaimer

References

    1. Marsland D, Mears SC (2012) A review of periprosthetic femoral fractures associated with total hip arthroplasty. Geriatr Orthop Surg Rehabil 3(3):107–120 - DOI - PubMed - PMC
    1. Bhattacharyya T, Chang D, Meigs JB, Estok DM, Malchau H (2007) Mortality after periprosthetic fracture of the femur. J Bone Jt Surg Am 89(12):2658–2662 - DOI
    1. Khan T, Grindlay D, Ollivere BJ, Scammell BE, Manktelow ARJ, Pearson RG (2017) A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Jt J 99:17–25 - DOI
    1. Ahmed SS, Haddad FS (2020) Periprosthetic fractures of the hip. Orthop Trauma 34(2):89–94 - DOI
    1. Lindahl H, Garellick G, Regnér H, Herberts P, Malchau H (2006) Three hundred and twenty-one periprosthetic femoral fractures. J Bone Jt Surg Am 88(6):1215–1222 - DOI

Publication types

MeSH terms

LinkOut - more resources