Tapered, fluted, modular, titanium stems in Vancouver B periprosthetic femoral fractures: an analysis of 87 consecutive revisions.

Abstract

One of the instruments in the orthopaedic surgeon's armamentarium to face the challenges associated with periprosthetic fracture around the stem of a hip replacement is the tapered, fluted, modular, titanium (TFMT) stem. Our aim was to study its clinical and radiological outcomes. During the period 2010-2016 86 patients (55 females; median age 78.2 years; mean BMI 26.3 kg/m2; median ASA classification 2) underwent 87 revisions for a Vancouver B periprosthetic fracture using a Stryker Restoration Cone-Conical stem. After a median follow-up of 2.9 years no stem had to be revised and no case of stem fracture was found. Dislocation was the most common complication and occurred in 18% of patients. Other major complications were deep infection (n = 4), subsidence >5 mm (n = 7), and nonunion (n = 5). 3-month and 1-year mortality was 10% and 15% respectively and was strongly correlated with age, deep infection, and ASA classification. The median EQ-5D health state index at final follow-up was 0.78 and all patients were ambulatory. The complication most commonly encountered was dislocation and can likely be prevented by the use of large heads, adequate reduction and fixation of the trochanteric area and restoration of the native anatomy. Contrary to previous concerns, fracture and subsidence of these modular stems do not appear to be a significant problem in this geriatric population.