Open Reduction Internal Fixation of 105 Vancouver B1 Periprosthetic Femur Fractures: High Mortality at Five Years.

BACKGROUND

Periprosthetic femoral fractures around well-fixed femoral components in total hip arthroplasty remain challenging to treat. The purpose of this study was to report implant survivorship, clinical outcomes, and radiographic results of a large series of operatively treated Vancouver B1 periprosthetic femoral fractures.

METHODS

We identified 105 Vancouver B1 fractures treated with open reduction internal fixation between 2001 and 2021. The cumulative incidences of revision and reoperation, accounting for death as a competing risk, were calculated. Mortality, complications, Harris Hip Scores, and radiographic outcomes were assessed. The mean follow-up was three years (range, zero to 16). Among 105 Vancouver B1 fractures, 71% occurred after primary total hip arthroplasty. The majority of the fractures were surrounding cementless implants (75%). The most common fixation construct was cerclage cables and a laterally-based plate (64%).

RESULTS

The five-year cumulative incidences of revision and reoperation were 14 and 18%, respectively. There were 12 revisions, of which seven were for fracture-related complications, including hardware removal (n = 3), nonunion (n = 3), and one periprosthetic fracture distal to the plate. The remaining revisions were for periprosthetic joint infection (n = 3), recurrent dislocation (n = 1), and aseptic loosening of a femoral component (n = 1). In addition to the 12 revisions, there were five reoperations, all debridement for superficial surgical site infections. Mortality at two years was 24%. The mean Harris Hip Score at a five-year follow-up was 83 (range, 60 to 100). Radiographic union was 96% at the final follow-up.

CONCLUSIONS

Vancouver B1 periprosthetic femoral fractures treated with open reduction internal fixation are associated with good clinical outcomes, with 96% radiographic union and a five-year revision rate of 14%. However, functional outcomes are modest, and in-hospital complication rates are high. Mortality remains high, mirroring rates following native hip fractures.

LEVEL OF EVIDENCE: III.