Abstract
Although stem revision is recommended for Vancouver B2 periprosthetic hip fractures (PPHFs), there has recently been a debate whether, under certain conditions, they could be treated by osteosynthesis alone. This study aimed to describe the medium-term clinical and radiological results of several patients with V-B2 fractures treated via osteosynthesis. A retrospective study of patients with V-B2 PPHF treated by osteosynthesis without stem revision, operated on between 2009 and 2019, was performed. The type of arthroplasty, type of stem, ASA, Charlson Comorbidity Index (CCI), medical and implant complications, reoperation rate, first-year mortality, radiological results (consolidation time), and functional results were analyzed. Thirty-nine patients were included. Their average age was 78.82 years. Most of the patients presented ASA ≥ 3 (35/39) and CCI ≥ 5 (32/39). Radiological consolidation was achieved in 93.5% of patients, with an average consolidation time of 92.93 days. The average Parker test score before admission was 5.84 while the current one was 4.92 (5.16 years follow-up). Osteosynthesis without stem revision is a valid surgical alternative in certain types of patients with V-B2 PPHF, depending on previous mobility, fracture pattern (anatomical reconstruction possible), anesthetic risk, comorbidities, and previous hip pain.
Highlights
This study aimed to describe the results achieved at our institution in patients with Vancouver B2 (V-B2) PPHF treated with osteosynthesis, by examining the consolidation rate, implant, and medical complications, as well as medium-term functional outcomes
Several studies have been published reporting good results in VB2 PPHF treated with osteosynthesis [4,5,11] and some of their authors have argued that the Vancouver classification, very useful, should include the patient’s previous functionality, the anesthetic risk, comorbidities, the possibility of achieving anatomical reduction, the stability of the cement mantle, age, and the surgeon’s experience in deciding what type of treatment to perform [5,8,9,11]
The decision on whether to perform osteosynthesis or stem revision is made based on the Vancouver classification, previous mobility, whether the fracture pattern [20] made anatomical reconstruction possible, anesthetic risk, comorbidities, previous hip pain, and the experience of the senior orthopedic surgeons
Summary
Periprosthetic hip fractures (PPHFs) are becoming increasingly common due to the ageing population and the rise in the number of hip replacements [1].The Vancouver classification [2] is the most used for managing patients with PPHF [3].According to the authors, type B2 fractures require stem revision using a longer stem.several authors have argued that under certain conditions, type B2 fractures could be successfully treated with the osteosynthesis technique [3,4,5,6,7,8,9,10,11].This study aimed to describe the results achieved at our institution in patients with Vancouver B2 (V-B2) PPHF treated with osteosynthesis, by examining the consolidation rate, implant, and medical complications, as well as medium-term functional outcomes. Periprosthetic hip fractures (PPHFs) are becoming increasingly common due to the ageing population and the rise in the number of hip replacements [1]. The Vancouver classification [2] is the most used for managing patients with PPHF [3]. Type B2 fractures require stem revision using a longer stem. Several authors have argued that under certain conditions, type B2 fractures could be successfully treated with the osteosynthesis technique [3,4,5,6,7,8,9,10,11]. This study aimed to describe the results achieved at our institution in patients with Vancouver B2 (V-B2) PPHF treated with osteosynthesis, by examining the consolidation rate, implant, and medical complications, as well as medium-term functional outcomes
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