Periprosthetic fractures of the proximal femur: Can we rely on the Vancouver classification as a prognostic tool?

Introduction

Periprosthetic fractures’ incidence is increasing, leading to growing concerns on their impact on patients’ clinical conditions and healthcare systems budgets. Aim: Evaluation of the clinical impact of periprosthetic fractures and their treatment on patients’ functionality and quality of life Materials and methods: We reviewed all hip periprosthetic fractures treated surgically between 2018 and 2024. Fractures were classified with the Vancouver classification. Surgical delay, surgical times, and postoperative hospitalization (days) were recorded. The number of blood units administered was counted. We also assessed whether cases could walk and bear weight on the treated limb after our treatments.

Results

Ninety-four cases with proximal femur periprosthetic fractures were included. (4 type A, 36 type B1, 30 type B2, 5 type B3, and 19 type C). Patients’ mean hospitalization was 10.6 days (5–27). Vancouver classes did not represent prognostic factors in our cohort. Seventy-eight cases experienced postoperative anemia and required transfusion. In our cohort, longer surgical delays led to longer postoperative hospitalizations. The complication rate was 11.7%. Nine percent of our cases died within six months after the fracture. During their follow-up, 65% of our patients had their preoperative walking ability restored; those who had complications were most likely to have reduced postoperative mobility.

Conclusion

The Vancouver classification is a useful tool for surgical planning, but does not represent a prognostic factor. Periprosthetic hip fractures can reduce patients’ walking ability, especially in case of complications, and even put at risk the survival of the most fragile patients.