Surgical treatments for Vancouver type B1 periprosthetic femoral fractures

Abstract

Objective To investigate the outcomes of the treatments for the patients with Vancouver type B1 periprosthetic femur fractures. Methods Seventeen patients with periprosthetic femoral fractures (5 males and 12 females; average age, 70.4 years, range from 37 to 86 years) who underwent revision arthroplasty or open reduction and internal fixation between December 2006 and June 2016 were retrospectively reviewed. Periprosthetic femoral fractures occurred at the mean time of 65.1 months after arthroplasty. Twelve patients underwent open reduction and internal fixation and five cases underwent total hip or stem revision with Solution from Depuy, Wagner from Zimmer, Echelon from Smith & Nephew or Secur-Fit Max from Stryker due to primary bone loss, acetabular component wear or long-time prosthesis use respectively. Data were collected at 1, 3, 6 and 12 months and then each year postoperatively. All patients were followed up, and the results of X-ray, postoperative Harris hip score, stability of prosthesis and complications were also evaluated. Results A total of 5 patients underwent revision arthroplasty, and 12 patients underwent open reduction and internal fixation. The mean follow-up duration was 56 months (range from 7 to 120 months). Total blood loss in the open reduction and internal fixation group and in revision group was 385±129 ml and 531±113 ml respectively. The operation duration in the open reduction and internal fixation group was 72±36 min while it was 126±48 min in the revision group. The postoperative Harris hip score in the open reduction and internal fixation group was significantly increased compared with preoperative Harris hip score (68.8±18.4 vs. 46.2±9.6), as well as in the revision group (75.0±8.9 vs. 57.4±13.0). For the incidence of complications, in the open reduction and internal fixation group, one patient suffer with delayed fracture union, one patient complained about persistent pain and one suffered a secondary fracture, while in the revision group one suffered from blood loss and one with long-term pain. Conclusion Open reduction and internal fixation is an optimal intervention for Vancouver B1 fracture, and revision arthroplasty can be considered as a safe alternative in patients with primary bone loss, implant of short survival time, severe liner wear or long-term prosthesis use. Key words: Arthroplasty, replacement, hip; Periprosthetic fractures; Femoral fractures; Reoperation; Fracture fixation, internal