Effectiveness of operative interventions in individuals with a hemi or total hip arthroplasty who sustain a Vancouver B2 peri-prosthetic femoral fracture

Abstract

Background: Peri-prosthetic femur (PPF) fractures around hip arthroplasties may occur intra or post-operatively, and although infrequent, are a significant complication imparting a heavy burden upon patient, orthopedic surgeon and the health care system. Although femoral revision arthroplasty is currently recommended for management of Vancouver Type B2 PPF fractures, open reduction internal fixation (ORIF) has been shown in some small studies to yield similar outcomes when compared to revision. Objective: This review aims to identify the effectiveness of operative interventions in individuals with a hemi or total hip arthroplasty (THA) who sustain a Vancouver type B2 peri-prosthetic femoral (PPF) fracture or equivalent. Specifically, this review will investigate ORIF and femoral revision arthroplasty with or without internal fixation. Methods: This review will consider studies including participants who sustain a Vancouver B2, or equivalent, PPF fracture in the post-operative setting. Studies evaluating ORIF by any method and femoral revision arthroplasty, with or without internal fixation will be considered. We will consider studies that include one or more of the following primary (below) or any of our secondary outcomes. Re-operation rate Fixation failure Stem migration Malunion Non-union Studies utilizing experimental, quasi-experimental and observational study designs will be considered. Keyword search (see below) will be undertaken in the following databases: PubMed, EMBASE, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science in addition to grey literature. Femoral fractures[mh] OR Femoral fracture*[tw] OR femur fracture*[tw] AND Periprosthetic[tw] OR peri-prosthetic[tw] or peri prosthetic[tw] AND Arthroplasty, replacement, hip[mh] OR hemiarthroplasty[mh] OR hip arthroplasty[tw] OR hip replacement[tw] OR hip hemiarthroplasty[tw] OR femoral fracture arthroplasty[tw] Results: Prior to study inclusion, dual independent reviewer critical analysis will take place using standardized instruments from the Joanna Briggs Institute (JBI). Furthermore, single reviewer data extraction and synthesis with aim of Meta-analysis (homogeneity permitting) will be completed using standardized tools including; JBI-System for the Unified Management, Assessment and Review of Information (SUMARI) and/or RevMan. Discussion: There is a paucity of literature assessing the comparative outcomes of type B2 fracture management by way of ORIF vs. femoral revision arthroplasty with or without internal fixation. No recent systematic review on the topic has been identified, thus a systematic review is required. Conclusion: Systematic review is in progress. We hypotheses that selected Vancouver type B2 PPF fractures can be successfully managed with open reduction internal fixation alone.