J Korean Orthop Assoc.  2013 Jun;48(3):197-204. 10.4055/jkoa.2013.48.3.197.

Femoral Stem Revision for Vancouver type B2 and B3 Periprosthetic Fractures

• Seong YJ
• Shin WC
• Cho HJ
• Lee JS
• Suh KT

• KMID: 2106673
• DOI: http://doi.org/10.4055/jkoa.2013.48.3.197

Abstract

PURPOSE
We evaluated the outcome of femoral stem revision for Vancouver B2 and B3 periprosthetic femoral fractures.
MATERIALS AND METHODS
We conducted a retrospective assessment of 15 patients who had received treatment for a periprosthetic unstable femoral fracture after primary hip arthroplasty between May 1997 and September 2009. According to Vancouver classification, 11 patients were type B2 and four were B3. Open reduction and long stem revision were performed in all 15 cases. In Vancouver type B3 fractures, we treated patients with open reduction and long stem revision with an allogenic cancellous bone graft, which is the same as in that used in Vancouver type B2 fractures. An allogenic onlay cortical bone graft was used when additional stability was required. The mean age of patients was 67.1 years at the time of surgery and the mean duration of follow-up was 31.5 months. We described the clinical and radiographic results.
RESULTS
Using Beals and Tower's criteria, fair to good clinical and radiologic results were observed at the latest follow up, with an average Harris hip score of 94.4 points. Fractures were united in all 15 patients. One patient had non-union of the greater trochanter of the femur, one patient had superficial infection, and one patient had non-union of onlay bone graft, however, there were no further complications, such as dislocations, periprosthetic infections, or nerve injuries. There was no loosening of the femoral stems.
CONCLUSION
In Vancouver type B2 and B3 fractures, when there is loosening of the femoral stems, open reduction and long stem revision with allogenic cancellous bone graft provided a satisfactory result. However, long-term follow up is needed.

Keyword

femur; periprosthetic fractures; Vancouver classification; surgical revision

MeSH Terms

Arthroplasty
Dislocations
Femoral Fractures
Femur
Follow-Up Studies
Hip
Humans
Inlays
Periprosthetic Fractures
Reoperation
Retrospective Studies
Transplants

Figure

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  Figure 1 Vancouver type B2 fracture: stem revision with onlay bone graft. Radiographs of a 74-year-old female with a Vancouver type B2 fracture. (A) The post-traumatic radiographs. The femoral stem had been sunken down remarkably. The fracture pattern was unstable; oblique fracture line with butterfly fragment. This patient had relatively fair bone stock. (B) The immediate postoperative radiographs. Supplementary fixation anterior to the fracture site with onlay bone graft and cables were needed. An extensively porous coated curved stem (8 inches, Solution, Depuy) was used. (C) The radiographs at the latest follow-up. Eight years after the operation, fracture was healed and the graft was successfully integrated.

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  Figure 2 Vancouver type B3 fractures. Radiographs of a 78-year-old male with a Vancouver type B3 fracuture. (A) The post-traumatic radiograph. A cemented stem was used at primary total hip replacement. The femoral stem had been sunken down remarkably with a fracture of the cement mantle. Note that the bone stock was mostly absent between the cortex and stem with severe cortical thinning preoperatively. (B) The immediate postoperative radiographs. We applied a massive cancellous impaction bone graft surrounding the extensively porous coated curved stem (10 inches, Solution, Depuy). (C) The radiographs at latest follow-up. Twelve months after the operation, the fracture was healed and bone formation was observed at the proximal femur.

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