Mid-term outcomes following transfemoral revision of total hip arthroplasty for Vancouver B2/B3 periprosthetic fractures

Abstract

IntroductionPeriprosthetic femoral fractures (PFF) are often the reason for revising total hip arthroplasty (RTHA). Converting these fractures into modified extended trochanteric osteotomy (mETO) facilitates stem revision. Modular revision stems are a common choice with good results. We present mid-term outcomes in patients undergoing RTHA for Vancouver B2/B3 PFF using a tapered, fluted modular stem with an mETO approach. Materials and methodsA single-center analysis of patients with RTHA for Vancouver B2/B3 PFF using a single modular implant with mETO was performed (2007 – 2019). Clinical outcome (mobility, range of motion, function), radiological outcome (fracture healing, stem subsidence) and patient reported outcome measures (FJS-12, HHS, EQ-5D) were assessed. ResultsNinety-seven patients (mean age 78.1 years, BMI 25.8 kg/m2, 85.6% B2-fractures) were included; 80 patients had complete clinical and radiological follow-ups. Normal unaided gait without limping was achieved in 38/80 patients. After one year fracture / mETO healing occurred in 74/80 patients; 5.3 years after surgery, the respective FJS-12, HHS and EQ-5D (available in 34 patients) averaged 81.3 ± 30.2, 71.4 ± 18.7 and 0.8 ± 0.2. We documented 7 in-hospital deaths, 18.8% postoperative complications and 13.8% revisions with stem revisions being most commonly for subsequent PFF or subsidence. ConclusionGood clinical and radiological outcomes and rather low complication and revision rates (18.8% and 13.8%) were achieved. FJS-12 showed excellent results in patients undergoing RTHA for Vancouver B2/B3 PFF using a cementless, dual modular titanium revision stem and an mETO approach. Joint awareness was thereby similar to previously reported primary THA results at 5.3 years follow-up.