Jong-Seok PARK, Sijohn HONG, Jae-Hwi NHO, Deokwon KANG, Hyung-Suk CHOİ, You-Sung SUH

Radiologic outcomes of open reduction and internal ﬁxation for cementless stems in Vancouver B2 periprosthetic fractures

Objective: The aim of this study was to evaluate the radiologic outcomes of open reduction and lateral plating with wiring in the treatment of Vancouver B2 periprosthetic femoral fractures. Methods: We retrospectively recruited 37 patients treated with ORIF with lateral plating and wiring for Vancouver B2 fractures. The 27 patients (15 men and 12 women; mean age: 70.8 ± 8.3 years) without follow-up loss had achieved complete bony union without notable complications. The average union period was checked after operation with radiologic ﬁndings. Radiologic outcomes were evaluated by ipsilateral limb length discrepancy (LLD) and subsidence between immediate postoperative length and length at postoperative 1 year after adjusting for magniﬁcation differences. The average distance to which the retained stem sunk downwas investigated between immediatepostoperative radiographs and ﬁnal radiographs showing union. Results: Tenpatients could not be evaluated, becauseof mortalityor failure tofollow up.The average time to union was 18.3 weeks, and the average distance of stem sinking was 2.5 ± 1.7 mm (range: 0e7.2 mm), which was signiﬁcantly different between immediate postoperative radiographs and ﬁnal radiographs. There was no case with loss of reduction or loss of ﬁxation, requiring revision surgery. Conclusion: Open reduction and lateral plating with wiring as a treatment for Vancouver B2 periprosthetic femoral fractures produced good radiologic outcomes with successful bony union. ORIF can be considered the alternative option for treating patients with Vancouver B2 PPF, instead of stem revision surgery.

___

Ricci WM. Periprosthetic femur fractures. J Orthop Trauma. 2015;29(3): 130e137.

Lewallen DG, Berry DJ. Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date. Instr Course Lect. 1998;47: 243e249.

Younger ADJ, Duncan C. Periprosthetic hip and knee fractures: the scope of the problem. Instr Course Lect. 1997;47:251e256.

Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007;38(6):651e654

Soenen M, Lautridou C, Lebel B, et al. Periprosthetic fractures around total hip and knee arthroplasty. Review of the literature. Rev Chir Orthop Reparatrice Appar Mot. 2006;92(5 Suppl):2S44e42S51.

Haasper C, Enayatollahi MA, Gehrke T. Treatment of Vancouver type B2 periprosthetic femoral fractures. Int Orthop. 2015;39(10):1989e1993.

Klein GR, Parvizi J, Rapuri V, et al. Proximal femoral replacement for the treatment of periprosthetic fractures. J Bone Joint Surg Am. 2005;87(8):1777e1781.

Sidler-Maier CC, Waddell JP. Incidence and predisposing factors of periprosthetic proximal femoral fractures: a literature review. Int Orthop. 2015;39(9):1673e1682.

Della Rocca GJ, Leung KS, Pape HC. Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma. 2011;25(Suppl 2):S66eS70.

Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect. 1995;44:293e304.

Moazen M, Jones AC, Jin Z, Wilcox RK, Tsiridis E. Periprosthetic fracture ﬁxation of the femur following total hip arthroplasty: a review of biomechanical testing. Clin Biomech (Bristol, Avon). 2011;26(1):13e22.

NiikuraT,LeeSY,SakaiY,NishidaK,KurodaR,KurosakaM.Treatmentresultsof a periprosthetic femoral fracture case series: treatment method for Vancouver type b2 fractures can be customized. Clin Orthop Surg. 2014;6(2):138e145.

Lunebourg A, Mouhsine E, Cherix S, Ollivier M, Chevalley F, Wettstein M. Treatment of type B periprosthetic femur fractures with curved non-locking plate with eccentric holes: retrospective study of 43 patients with minimum 1-year follow-up. Orthop Traumatol Surg Res. 2015;10(3):277e282.

Masri BA, Meek RM, Duncan CP. Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res. 2004;(420):80e95.

O'Shea K, Quinlan JF, Kutty S, Mulcahy D, Brady OH. The use of uncemented extensively porous-coated femoral components in the management of Vancouver B2 and B3 periprosthetic femoral fractures. J Bone Joint Surg Br. 2005;87(12):1617e1621.

McKelvie SJ. Does memory contaminate test-retest reliability? J Gen Psychol. 1992;119(1):59e72.

Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classiﬁcation and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty. 2005;20(7): 857e865.

Parvizi J, Vegari DN. Periprosthetic proximal femur fractures: current concepts. J Orthop Trauma. 2011;25(Suppl 2):S77eS81.

Pike J, Davidson D, Garbuz D, Duncan CP, O'Brien PJ, Masri BA. Principles of treatment for periprosthetic femoral shaft fractures around well-ﬁxed total hip arthroplasty. J Am Acad Orthop Surg. 2009;17(11):677e688.

Ricci WM, Haidukewych GJ. Periprosthetic femoral fractures. Instr Course Lect. 2009;58:105e115.

Haddad FS, Duncan CP, Berry DJ, Lewallen DG, Gross AE, Chandler HP. Periprosthetic femoral fractures around well-ﬁxed implants: use of cortical onlay allografts with or without a plate. J Bone Joint Surg Am. 2002;84-A(6):945e950.

Lee SR, Bostrom MP. Periprosthetic fractures of the femur after total hip arthroplasty. Instr Course Lect. 2004;53:111e118.

Broden C, Mukka S, Muren O, et al. High risk of early periprosthetic fractures after primary hip arthroplasty in elderly patients using a cemented, tapered, polished stem. Acta Orthop. 2015;86(2):169e174.

Drexler M, Dwyer T, Chakravertty R, Backstein D, Gross AE, Saﬁr O. The outcome of modiﬁed extended trochanteric osteotomy in revision THA for Vancouver B2/B3 periprosthetic fractures of the femur. J Arthroplasty. 2014;29(8):1598e1604.

Munro JT, Garbuz DS, Masri BA, Duncan CP. Tapered ﬂuted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures. Clin Orthop Relat Res. 2014;472(2):590e598.

Franklin J, Malchau H. Risk factors for periprosthetic femoral fracture. Injury. 2007;38(6):655e660.

Anakwe RE, Aitken SA, Khan LA. Osteoporotic periprosthetic fractures of the femur in elderly patients: outcome after ﬁxation with the LISS plate. Injury. 2008;39(10):1191e1197.

Bhattacharyya T, Chang D, Meigs JB, Estok 2nd DM, Malchau H. Mortality after periprosthetic fracture of the femur. J Bone Joint Surg Am. 2007;89(12): 2658e2662.

Young SW, Walker CG, Pitto RP. Functional outcome of femoral peri prosthetic fracture and revision hip arthroplasty: a matched-pair study from the New Zealand Registry. Acta Orthop. 2008;79(4):483e488.

Kumar V, Kanabar P, Owen PJ, Rushton N. Less invasive stabilization system for the management of periprosthetic femoral fractures around hip arthroplasty. J Arthroplasty. 2008;23(3):446e450.

Park SK, Kim YG, Kim SY. Treatment of periprosthetic femoral fractures in hip arthroplasty. Clin Orthop Surg. 2011;3(2):101e106.

Lever JP, Zdero R, Nousiainen MT, Waddell JP, Schemitsch EH. The biomechanical analysis of three plating ﬁxation systems for periprosthetic femoral fracture near the tip of a total hip arthroplasty. J Orthop Surg Res. 2010;5(45): 45.

Demos HA, Briones MS, White PH, Hogan KA, Barﬁeld WR. A biomechanical comparison of periprosthetic femoral fracture ﬁxation in normal and osteoporotic cadaveric bone. J Arthroplasty. 2012;27(5):783e788.

WoodGC,NaudieDR,McAuleyJ, McCalden RW.Locking compression platesfor the treatment of periprosthetic femoral fractures around well-ﬁxed total hip and knee implants. J Arthroplasty. 2011;26(6):886e892.

Zdero R, Walker R, Waddell JP, Schemitsch EH. Biomechanical evaluation of periprosthetic femoral fracture ﬁxation. J Bone Joint Surg Am. 2008;90(5): 1068e1077.

Moazen M, Mak JH, Etchels LW, et al. Periprosthetic femoral fracture–a biomechanical comparison between Vancouver type B1 and B2 ﬁxation methods. J Arthroplasty. 2014;29(3):495e500.

Gulsen M, Karatosun V, Uyulgan B. The biomechanical assessment of ﬁxation methods in periprosthetic femur fractures. Acta Orthop Traumatol Turc. 2011;45(4):266e269.

Suh YS, Nho JH, Kim SM, Hong S, Choi HS, Park JS. Clinical and radiologic outcomes among bipolar hemiarthroplasty, compression hip screw and proximal femur nail antirotation in treating comminuted intertrochanteric fractures. Hip Pelvis. 2015;27(1):30e35.

Kwong LM, Miller AJ, Lubinus P. A modular distal ﬁxation option for proximal bone loss in revision total hip arthroplasty: a 2- to 6-year follow-up study. J Arthroplasty. 2003;18(3 Suppl 1):94e97.

Ovesen O, Emmeluth C, Hofbauer C, Overgaard S. Revision total hip arthroplasty using a modular tapered stem with distal ﬁxation: good short-term results in 125 revisions. J Arthroplasty. 2010;25(3):348e354.

Rodriguez JA, Deshmukh AJ, Klauser WU, Rasquinha VJ, Lubinus P, Ranawat CS. Patterns of osseointegration and remodeling in femoral revision with bone loss using modular, tapered, ﬂuted, titanium stems. J Arthroplasty. 2011;26(8): 1409e1417. e1401.