Femoral Stem Revision for Vancouver type B2 and B3 Periprosthetic Fractures

Abstract

Purpose: We evaluated the outcome of femoral stem revision for Vancouver B2 and B3 periprosthetic femoral fractures. Materials and Methods: We conducted a retrospective assessment of 15 patients who had received treatment for a periprosthetic unstable femoral fracture after primary hip arthroplasty between May 1997 and September 2009. According to Vancouver classification, 11 patients were type B2 and four were B3. Open reduction and long stem revision were performed in all 15 cases. In Vancouver type B3 fractures, we treated patients with open reduction and long stem revision with an allogenic cancellous bone graft, which is the same as in that used in Vancouver type B2 fractures. An allogenic onlay cortical bone graft was used when additional stability was required. The mean age of patients was 67.1 years at the time of surgery and the mean duration of follow-up was 31.5 months. We described the clinical and radiographic results. Results: Using Beals and Tower’s criteria, fair to good clinical and radiologic results were observed at the latest follow up, with an average Harris hip score of 94.4 points. Fractures were united in all 15 patients. One patient had non-union of the greater trochanter of the femur, one patient had superficial infection, and one patient had non-union of onlay bone graft, however, there were no further complications, such as dislocations, periprosthetic infections, or nerve injuries. There was no loosening of the femoral stems. Conclusion: In Vancouver type B2 and B3 fractures, when there is loosening of the femoral stems, open reduction and long stem revision with allogenic cancellous bone graft provided a satisfactory result. However, long-term follow up is needed.