Operatively Managed Transverse or Short Oblique B1 Periprosthetic Fractures Around a Polished Taper-Slip Femoral Stem Are Associated With Reoperation in One Third of Cases: A Retrospective Cohort Study.

BACKGROUND

Transverse or short oblique periprosthetic femoral fractures around total hip arthroplasty (THA) stems are typically classified as B1 fractures (stem well-fixed) and usually managed with fixation. These fractures have high non-union rates. This study aimed to identify reoperation rates in patients with operatively managed transverse or short oblique fractures around a cemented polished taper-slip stem and determine any associations with treatment failure.

METHODS

This retrospective cohort study included 31 patients with Arbeitsgemeinschaft für Osteosynthesefragen transverse or short oblique Vancouver B1 periprosthetic femoral fractures around THA with a cemented taper slip stem: 12 males (39%); mean age 74 ± 11.9 years (range 44-91); mean BMI 28.5 ± 1.4 (range 16-48); median American Society of Anesthesiologists score 3. Patient journeys were assessed and re-interventions recorded. The primary outcome was reoperation.

RESULTS

The mean time from primary THA to fracture was 11.3 ± 7.8 years (0.5-26 years). Surgical management involved fixation in 27/31 cases and revision-THA (r-THA) in 4/31. Ten patients (32%) required reoperation (8 following ORIF and 2 following r-THA, P = .584), most commonly within 2 years of injury (9/10) due to non-union (6/10). No significant associations with reoperation requirement were identified. Kaplan-Meier survival free from reoperation was 67.4% (95% CI 49.8-85.0) at 2 years, unaffected by initial management with fixation or revision (Log rank 0.898). Of those reoperated, 60% (6/10) required multiple reoperations to achieve bony union or a stable revision construct.

CONCLUSIONS

These fractures are challenging to manage with either fixation or revision. Patients should be counseled about a one in 3 risk of reoperation and a one in 5 risk of requiring multiple reoperations.