Preoperative Planning and Surgical Technique in the Management of Periprosthetic Femoral Fractures Using a Tapered Modular Fluted Prosthesis With Distal Fixation

Abstract

The number of periprosthetic femoral fractures is on the rise with the increasing prevalence of primary and revision hip arthroplasty and the longer life expectancy of the population. The management of these fractures is difficult. We describe the preoperative planning and the operative technique for the management of Vancouver B2 and B3 fractures, using a tapered, fluted, modular, distally fixed, cementless stem. We reviewed the results of 14 patients who underwent revision arthroplasty with the above technique with Vancouver type B2 and B3 femoral fractures. The average age of the patient was 67.3 years. There were 12 Vancouver type B2 and 2 Vancouver type B3 fractures. The mean follow-up time was 3.34 years. The average operative time was 194 minutes and the average blood loss was 1007 mL. At the most recent follow-up of the patients, the mean Harris hip score was 83.9. Radiographic evaluation revealed periprosthetic fracture union in all the cases and no hips showed subsidence beyond 2 mm. There were 2 cases of dislocation of the hip joint and 2 cases of superficial wound infection. This technique has proven to be reliable in the treatment of difficult fractures in this population.