Treatment of Vancouver B2 and B3 Periprosthetic Femoral Fractures Using a Modular Tapered Stem: Survivorship and Radiographic Outcomes at Mean 7.8-Year Follow-Up.

INTRODUCTION

Periprosthetic fractures (PPF) of the femur are a frequent complication following total hip arthroplasty (THA). Revision THA using a modular tapered stem is a common treatment strategy for these fractures. The purpose of this study was to report the survivorship and clinical outcomes of revision THA using a modular tapered femoral stem to treat PPF of the femur.

METHODS

A total of 46 patients were included from our retrospective review of revision total hip arthroplasties performed for Vancouver B2 and B3 fractures between January 2001 and December 2022. A minimum follow-up of two years was required. Among these patients, 30 (65.2%) were women, the mean age at the time of surgery was 73 years (range, 33 to 93), and the mean follow-up was 7.6 years (range, 2.0 to 22.6). Overall, 67.4% (31 of 46) patients were classified as Vancouver B2 fractures. Kaplan-Meier survivorship analysis was conducted with failure defined as revision surgery for any reason.

RESULTS

Kaplan-Meier survivorship due to all-cause failure for patients who underwent revision THA to treat PPF via a modular tapered stem was 95.1% (95% CI [confidence interval]: 88.7 to 100.0) at 15 years with four hips at risk. The overall complication rate was 13.0% (six of 46), which included dislocation (four), infection (one), and iliopsoas tendonitis (one). The overall revision rate was 4.3% (two of 46), with revisions performed for dislocation (one) and infection (one). Overall, 95.2% (40 of 42) of patients were ambulatory at final follow-up.

CONCLUSION

Our study suggests revision THA using a modular tapered femoral stem for Vancouver B2 and B3 PPF of the femur is a viable treatment option, providing excellent 10- to 15-year survivorship and radiographic outcomes with a low complication rate. Future research should evaluate patient-reported outcomes and longer-term follow-up in larger cohorts.