In Brief: Classifications in Brief: Vancouver Classification of Postoperative Periprosthetic Femur Fractures

Abstract

With a growing elderly population, the rates of primary and revision THAs also have increased. Paralleling the increased number of hip reconstructive procedures performed is the incidence of periprosthetic femur fractures [14]. Each periprosthetic fracture poses a unique challenge to the treating orthopaedic surgeon because of the many variables that must be considered with each fracture pattern. These variables include the relationship of the fracture to the implant, the specifics of the implant including wear, and the functional demands of the patient. A couple studies outline the impact of periprosthetic femur fractures on mortality. Lindahl et al. investigated outcomes in patients from the Swedish national hip arthroplasty register and described higher mortality rates after surgery for patients with periprosthetic femoral fractures compared with patients who had total hip replacements [16]. Bhattacharyya et al. similarly found an increased mortality rate of 11% at 1 year (21% cumulative mortality rate) in patients treated operatively for periprosthetic femur fractures compared with a rate of 2.9% in patients who underwent primary joint arthroplasties [3]. They recorded mortality rates approaching those documented after hip fracture (16.5%), and also noted a nearly threefold increase in mortality in patients who sustained a fracture at the level of the prosthesis and were treated with open reduction and internal fixation versus patients treated with revision arthroplasty [3]. The Vancouver classification developed by Duncan and Masri [10] and Masri et al. [17] is the most widely accepted classification scheme to group fractures with similar characteristics from which a treatment algorithm is derived. Previous classification schemes and treatment algorithms for periprosthetic femur fractures focused primarily on location, fracture pattern, implant stability, and/or potential for loosening [2, 7, 13, 18, 21]. The Vancouver classification assimilates three key factors: location, stability of the implant, and the surrounding bone stock (Table 1). The classification has since been modified by Masri et al. to include intraoperative in addition to postoperative periprosthetic femur fractures [17]. The remainder of this discussion will focus on the Vancouver classification of postoperative periprosthetic femur fractures.