Abstract
IntroductionHip arthroplasty (HA) is commonly performed to treat various hip pathologies. Its volume is expected to rise further due to the increasing age of the population. Complication rates are low; however, periprosthetic femoral fractures (PFF) are a rare, albeit serious, complication with substantial economic impact. While current guidelines propose revision with long-stemmed prostheses for all Vancouver B2 and B3 PFF, some recent research papers suggest that open reduction with internal fixation (ORIF) could lead to an equivalent outcome. Our aim was to summarize the evidence, elucidating under which circumstances ORIF leads to a favorable outcome after B2 and B3 PFF compared with revision surgery.Materials and methodsA systematic literature search was performed to identify studies on patients treated with ORIF and with stem revision after B2 and/or B3 fractures. Extracted information included initial pathology, stem fixation mechanism, bone quality and stem stability at the time of PFF, clinical outcomes, and mortality. Results of individual studies were summarized in a table in lieu of a quantitative data synthesis due to a lack of standardized information.ResultsWe identified 14 original research articles including both patients treated with ORIF and with stem revision after B2 and/or B3 PFF. Five studies included statistical comparisons, all were in favor of ORIF or indeterminate. The common lack of rigorous statistical analyses and significant methodological weaknesses made identification of outcome predictors impossible.ConclusionThe choice of treatment modality for PFF depends on fracture, implant, and bone characteristics. Recent data show that successful outcome can be achieved without revising loose stems. ORIF may be a viable option if bone stock is adequate around uncemented or tapered polished stems with an intact cement mantle and the fracture geometry allows stable anatomic reconstruction. Conceptional considerations support this idea, but more data are needed to identify outcome predictors.
Highlights
Hip arthroplasty (HA) is commonly performed to treat various hip pathologies
Publications were deemed eligible if they were original research articles that included both patients treated with open reduction with internal fixation (ORIF) and patients treated with stem revision after a Vancouver B2 or B3 fractures and were published 1999 or later
Our systematic search identified 14 original studies that included patients treated with ORIF and patients treated with revision arthroplasty in the treatment of B2 and B3 periprosthetic femoral fractures (PFF) [5, 16, 19,20,21,22,23,24,25,26,27, 30,31,32]
Summary
Hip arthroplasty (HA) is commonly performed to treat various hip pathologies. Its volume is expected to rise further due to the increasing age of the population. Materials and methods A systematic literature search was performed to identify studies on patients treated with ORIF and with stem revision after B2 and/or B3 fractures. Results We identified 14 original research articles including both patients treated with ORIF and with stem revision after B2 and/or B3 PFF. ORIF may be a viable option if bone stock is adequate around uncemented or tapered polished stems with an intact cement mantle and the fracture geometry allows stable anatomic reconstruction. Conceptional considerations support this idea, but more data are needed to identify outcome predictors. The National Joint Registry of England and Wales reported a 1.5- and 1.6fold increase in periprosthetic fractures around hybrid and cemented hip prosthesis respectively between 2011 [9] and 2016 [10] alone, while it remained stable for uncemented HAs
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