Application of a cementless modular revision femoral prosthesis for Vancouver B2 periprosthetic femoral fractures

Abstract

Objective To evaluate the clinical effects in treating periprosthetic femoral fractures classified Vancouver B2 with a cementless modular revision femoral prosthesis. Methods Twenty-six patients (7 males and 19 females with mean age of 66.5 years, range 60-69 years) who suffered from periprosthetic femoral fractures classified Vancouver B2 were treated with a cementless modular revision femoral prosthesis in hip revision and open reduction and internal fixation with cables or plates from March 2007 to February 2014. The previous femoral prostheses included 21 cementless and 5 cemented hip stems. The period from former procedures to fractures was 16 months, range from 7 to 32 months. Harris hip scores and numerical rating scales were analyzed statistically. Time of leaving bed, discharging, fracture union postoperative complications and radiographic imaging were also recorded. Results The operation duration were 143 (range 105-165) minutes. Blood loss volume was 450 (range 270-780) ml. Blood transfusion volume were 330 (range 0-800) ml. All patients were followed up at least two years, averagely 3.5 years after surgeries. All fractures healed at 6.5 (range 3-12) months averagely after surgeries. Harris hip scores improved significantly from 11.8±2.5 before surgeries to 80.3±5.3 one month and to 91.4±7.3 six months after surgeries separately (F=0.715, P=0.001). Numerical rating scales were 9.6±0.3, 9.4±0.4 and 9.1±0.7 points averagely in aspect of information acquisition, postoperative pain control and function recovery respectively one month after surgeries. Average time of leaving bed and discharging from surgeries was 68.3 (range 51-75) hours and 6.5 (range 5-9) days respectively. No postoperative complications was found except dislocation in 1 hip, lower limb discrepancy in 1 hip, DVT in 1 hip, and heterotopic ossification in 3 hips. Conclusion Due to achieving prosthetic stability and fracture union, periprosthetic femoral fractures classified Vancouver B2 treated with a cementless modular revision femoral prosthesis combined with open reduction and internal fixation with cables or plates can reach good clinical outcomes. Key words: Arthroplasty, replacement, hip; Periprosthetic fractures; Femur; Bioprosthesis