Outcomes of Vancouver B2-type and B3-type proximal femur periprosthetic fractures after revision surgery using cementless tapered modular stem: a retrospective case series of 39 fractures

Abstract

Objective. Evaluate outcomes of Vancouver B2-type and B3-type proximal femur periprosthetic fractures (PPFs) in elderly patients treated with a cementless tapered modular femoral stem. Methods. 37 patients with a proximal femur PPF (34 B2-type and 5 B3-type) on primary or revision implants, with a minimum of 2-year follow-up, treated with revision of the failed stem using uncemented MP® reconstruction system stem (Waldemar Link®), were included.Results. At last follow-up, the average Harris Hip Score was 91 ± 9.8, and average Numerical Rating Score was 0.7 ± 0.8, without a significant difference between B2-type and B3-type PPFs. X-rays at last follow-up revealed bone union in all patients. According to Beals and Tower’s criteria, we found excellent radiological findings in 89.7% patients. Fourteen local surgery-related complications were reported (35.9%), and 4 patients required revision surgery (10.2%), without significant differences between B2-type and B3-type PPFs. We found involvement of both trochanters in fracture as a possible risk factor for dislocation.Conclusions. Vancouver B2-type and B3-type PPFs can be effectively treated using a cementless modular stem, even without cortical struts graft, although further studies are needed regarding B3-type PPFs.