Treatment of Vancouver B2 and B3 periprosthetic fractures of the femur.
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Published:
Mar 18, 2013
Keywords:
Hip periprosthetic fracture, Cemented long-stem, cementless long-stem, Hip revision
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Abstract
BackgroundPeriprosthetic fractures of the femur are becoming more prevalent. When this fracture occurs in a loose stem (B2) or with bone loss (B3), the treatment is femoral stem revision.MethodsWe analyzed retrospectively 22 patients, 9 with type B2 fractures and 13 with type B3 fractures of the Vancouver classification. Follow-up averaged 48 months. We used cemented long stems, with impacted bone allograft, strut allograft, uncemented long stems (with distal fixation) and unconventional endoprosthesis according to the case.ResultsAll fractures healed and remodeled. The complications were 2 (9%) dislocations, 1 (4.5%) infection, 1 (4.5%) calcar fracture, 1 (4.5%) loosening of cemented acetabular component and 2 (9%) deaths.Conclusions The periprosthetic femoral fractures B2 and B3 require replacement of the femoral stem, while there is a trend to use uncemented stems; in this series due to the overlap of treatments according to each subtype of fracture, there were no differences between the use of cemented stems with allograft or uncemented stem. In cases of severe bone loss the unconventional endoprosthesis offer a treatment option for patients with low functional demand. The Vancouver classification is a useful tool to guide the surgeon on the treatment.
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Garabano, G., Pesciallo, C. A., Nazur, G., Arroquy, D., & del Sel, H. (2013). Treatment of Vancouver B2 and B3 periprosthetic fractures of the femur. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 77(4), 252-259. https://doi.org/10.15417/37
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Clinical Research
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References
1. Beals RK, Tower SS. Periprosthetic fractures of the femur. Clin Orthop 1996;327:238-46.
2. Berry DJ. Periprosthetic fractures associated with osteolysis. J Arthroplasty 2003;18(3):107-11.
3. Bethea JS, DeAndrade JR, Welch RB. Proximal femur fractures following total hip arthroplasty. Clin Orthop 1982;170:95-106.
4. Duncan CP, Masri BA. Fractures of the femur after hip replacement. Inst Course Lect 1995;45:293-304.
5. Masri BA, Meek RMD, Duncan CP. Periprosthetic fractures evaluation and treatment. Clin Orthop 2004;420:80-95.
6. Brady OH, Masry BA. The reliability and validity of the Vancouver Classification of femoral fractures after hip replacement. J Arthroplasty 2000;62:159-62.
7. Böhm P, Bischel O. Femoral revision with Wagner SL revision stem. J Bone Joint Surg Am 2001;83:1023-31.
8. Christensen CM, Seger BM, Schultz RB. Management of intraoperative femur fractures associated with revision hip arthroplasty. Clin Orthop 1989;248:77-80.
9. Morales del Cano JJ, Hernandez JA. Fracturas periprotésicas del fémur. Rev Asoc Argent Ortop Traumatol 2005;70(4):334-8.
10. Olivetto R, Roitman G. Fracturas femorales periprotésicas. Rev Asoc Arg Ortop Traumatol 2007;72:123-9.
11. Cooke PH, Newman JH. Fractures of the femur in relation to cemented prostheses. J Bone Joint Surg Br 1998;12:1067-70.
12. Vedoya SP, Garabano G, del Sel H. Reemplazo de cadera con megaprótesis en patología no tumoral. Rev Asoc Argent Ortop
Traumatol 2009;74:282-9.
13. Abendschein W. Periprosthetic femur fractures: a growing epidemic. J Orthop 2003;30:235-9.
14. Giannoudis PV, Tsiridis E. Principles of internal fixation and selection of implants for periprosthetic femoral fractures. J Care Injury 2007;38:669-87.
15. Gomez HA. Fracturas periprotésicas de la cadera. Rev Asoc Argent Ortop Traumatol 2011;76:184-193.
16. Gross AE, Wong P. The use of structural allograft for treating periprosthetic fractures about the hip and knee. Orthop Clin North Am 1999;30:259-64.
17. Berry DJ. Treatment of Vancouver B3 periprosthetic femur fracture with a fluted tapered stem. Clin Orthop 2003;417:224-31.
18. Lindahl H, Oden A, Garellick G. Risk factor for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br 2006;88:26-30.
19. Lindahl H, Malchau H, Herberts P. Periprosthetic femoral fractures classification and demographic of 1049 PFF from Swedish Nat Hip Arthrop Reg. J Arthroplasty 2005;20:857-62.
20. Tower SS, Beals RK. Fractures of the femur after hip replacement. Orthop Clin North Am 1999;30:235-47.
21. Koolstad K. Revision THR after periprosthetic femoral fracture. Acta
Orthop Scand 1994;65:505-8.
22. Ko PS, Lee OB, Lam JJ. Distal fixation with Wagner revision stem in treating Vancouver type B2 periprothesic femur fracture in geriatric patients. J Arthroplasty 2003;18:4:446-52.
23. Levine BR, Della Valle CJ, Prprosky W. Extended trochanteric osteotomy for the treatment of Vancouver B2/B3 periprosthetic
fractures of the femur. J Arthroplasty 2008;23(4):527-33.
24. Leopold SS, Rosemberg AG. Current status impaction allografting for revision of femoral component. Inst Course Lect 2000;49:111-18.
25. Johansson JE, Mc Broom R, Barrington TW. Fracture of the ipsilateral femur in patients with total hip arthroplasty. J Bone Joint Surg Am 1981;63:1435-42.
26. Farfalli LA, Bazan O, Levi A. Tratamiento de las fracturas homolaterales del fémur en artroplastias totales de cadera. Rev
Asoc Argent Ortop Traumatol 1991;56(4):431-43.
27. Lewallen DG, Berry DJ. Periprosthetic fractures of the femur after total hip arthroplasty. Inst Course Lect 1998;47:243-9.
28. Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. J Care Injury 2007:38:651-54.
29. Malkani AL, Paiso JM. Proximal femoral replacement with a megaprosthesis. Inst Course Lect 2000;49:144-6.
30. Malkani AL, Sim FH. Long term results of proximal femoral replacements for non neoplastic disorder. J Bone Joint Surg Br
1995;77:351-6.
31. Schmidt AH, Kyle RF. Periprosthetic fractures of the femur. Orthop Clin North Am 2002;1:143-52.
32. Tsiridis E, Haddad FS, Gie GA. Impaction femoral allografting and cemented revision for periprosthetic femoral fractures. J Bone Joint Surg Br 2004,86:1124-32.
33. Halliday BR, Timperley AJ, Gie GA, Ling RSM. Femoral impaction grafting with cement in revision THR. J Bone Joint Surg 2003;85(6):809-19.
34. Pekkarinen J, Alho A, Lepisto J. Impaction bone grafting in revision hip surgery: a high incidence of complications. J Bone Joint Surg Br 2000;82:103-7.
35. Morrey BF, Kavanagh BF. Complications with revision of the femoral component of THA. J Arthroplasty 1992;7:71-9.
36. Springer BD, Berry DJ. Treatment of periprosthetic femoral fractures following total hip arthroplasty with femoral component revision. J Bone Joint Surg Am 2003;85:2156-62.
37. Eldridge JD, Smith EJ, Learmouth ID. Massive early subsidence following femoral impaction grafting. J Arthroplasty 1997;12:535-40.
38. Mc Donald SJ, Paprosky WG. Periprosthetic femoral fracture treated with a long stem cementless component. J Arthroplasty 2001;16:379-83.
39. Morand MC. Treatment of periprosthetic femoral fracture around total hip arthroplasty with extensive coated femoral component. J Arthroplasty 1996;11:981-8.
40. Incavo SJ, Beard DM. One-stage revision of periprosthetic fractures around loose total hip arthroplasty. Am J Orthop 1998;27:35-41.
41. Mont MA, Maar DC. Fractures of the ipsilateral femur after hip arthroplasty. J Arthroplasty 1994;9(5):511-9.
42. Mauri AC, Pressman A, Gross A. Proximal femoral allograft treatment of Vancouver type B3 periprosthetic femoral fractures after total hip arthroplasty. J Bone Joint Surg Am 2006;88:953-8.
2. Berry DJ. Periprosthetic fractures associated with osteolysis. J Arthroplasty 2003;18(3):107-11.
3. Bethea JS, DeAndrade JR, Welch RB. Proximal femur fractures following total hip arthroplasty. Clin Orthop 1982;170:95-106.
4. Duncan CP, Masri BA. Fractures of the femur after hip replacement. Inst Course Lect 1995;45:293-304.
5. Masri BA, Meek RMD, Duncan CP. Periprosthetic fractures evaluation and treatment. Clin Orthop 2004;420:80-95.
6. Brady OH, Masry BA. The reliability and validity of the Vancouver Classification of femoral fractures after hip replacement. J Arthroplasty 2000;62:159-62.
7. Böhm P, Bischel O. Femoral revision with Wagner SL revision stem. J Bone Joint Surg Am 2001;83:1023-31.
8. Christensen CM, Seger BM, Schultz RB. Management of intraoperative femur fractures associated with revision hip arthroplasty. Clin Orthop 1989;248:77-80.
9. Morales del Cano JJ, Hernandez JA. Fracturas periprotésicas del fémur. Rev Asoc Argent Ortop Traumatol 2005;70(4):334-8.
10. Olivetto R, Roitman G. Fracturas femorales periprotésicas. Rev Asoc Arg Ortop Traumatol 2007;72:123-9.
11. Cooke PH, Newman JH. Fractures of the femur in relation to cemented prostheses. J Bone Joint Surg Br 1998;12:1067-70.
12. Vedoya SP, Garabano G, del Sel H. Reemplazo de cadera con megaprótesis en patología no tumoral. Rev Asoc Argent Ortop
Traumatol 2009;74:282-9.
13. Abendschein W. Periprosthetic femur fractures: a growing epidemic. J Orthop 2003;30:235-9.
14. Giannoudis PV, Tsiridis E. Principles of internal fixation and selection of implants for periprosthetic femoral fractures. J Care Injury 2007;38:669-87.
15. Gomez HA. Fracturas periprotésicas de la cadera. Rev Asoc Argent Ortop Traumatol 2011;76:184-193.
16. Gross AE, Wong P. The use of structural allograft for treating periprosthetic fractures about the hip and knee. Orthop Clin North Am 1999;30:259-64.
17. Berry DJ. Treatment of Vancouver B3 periprosthetic femur fracture with a fluted tapered stem. Clin Orthop 2003;417:224-31.
18. Lindahl H, Oden A, Garellick G. Risk factor for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br 2006;88:26-30.
19. Lindahl H, Malchau H, Herberts P. Periprosthetic femoral fractures classification and demographic of 1049 PFF from Swedish Nat Hip Arthrop Reg. J Arthroplasty 2005;20:857-62.
20. Tower SS, Beals RK. Fractures of the femur after hip replacement. Orthop Clin North Am 1999;30:235-47.
21. Koolstad K. Revision THR after periprosthetic femoral fracture. Acta
Orthop Scand 1994;65:505-8.
22. Ko PS, Lee OB, Lam JJ. Distal fixation with Wagner revision stem in treating Vancouver type B2 periprothesic femur fracture in geriatric patients. J Arthroplasty 2003;18:4:446-52.
23. Levine BR, Della Valle CJ, Prprosky W. Extended trochanteric osteotomy for the treatment of Vancouver B2/B3 periprosthetic
fractures of the femur. J Arthroplasty 2008;23(4):527-33.
24. Leopold SS, Rosemberg AG. Current status impaction allografting for revision of femoral component. Inst Course Lect 2000;49:111-18.
25. Johansson JE, Mc Broom R, Barrington TW. Fracture of the ipsilateral femur in patients with total hip arthroplasty. J Bone Joint Surg Am 1981;63:1435-42.
26. Farfalli LA, Bazan O, Levi A. Tratamiento de las fracturas homolaterales del fémur en artroplastias totales de cadera. Rev
Asoc Argent Ortop Traumatol 1991;56(4):431-43.
27. Lewallen DG, Berry DJ. Periprosthetic fractures of the femur after total hip arthroplasty. Inst Course Lect 1998;47:243-9.
28. Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. J Care Injury 2007:38:651-54.
29. Malkani AL, Paiso JM. Proximal femoral replacement with a megaprosthesis. Inst Course Lect 2000;49:144-6.
30. Malkani AL, Sim FH. Long term results of proximal femoral replacements for non neoplastic disorder. J Bone Joint Surg Br
1995;77:351-6.
31. Schmidt AH, Kyle RF. Periprosthetic fractures of the femur. Orthop Clin North Am 2002;1:143-52.
32. Tsiridis E, Haddad FS, Gie GA. Impaction femoral allografting and cemented revision for periprosthetic femoral fractures. J Bone Joint Surg Br 2004,86:1124-32.
33. Halliday BR, Timperley AJ, Gie GA, Ling RSM. Femoral impaction grafting with cement in revision THR. J Bone Joint Surg 2003;85(6):809-19.
34. Pekkarinen J, Alho A, Lepisto J. Impaction bone grafting in revision hip surgery: a high incidence of complications. J Bone Joint Surg Br 2000;82:103-7.
35. Morrey BF, Kavanagh BF. Complications with revision of the femoral component of THA. J Arthroplasty 1992;7:71-9.
36. Springer BD, Berry DJ. Treatment of periprosthetic femoral fractures following total hip arthroplasty with femoral component revision. J Bone Joint Surg Am 2003;85:2156-62.
37. Eldridge JD, Smith EJ, Learmouth ID. Massive early subsidence following femoral impaction grafting. J Arthroplasty 1997;12:535-40.
38. Mc Donald SJ, Paprosky WG. Periprosthetic femoral fracture treated with a long stem cementless component. J Arthroplasty 2001;16:379-83.
39. Morand MC. Treatment of periprosthetic femoral fracture around total hip arthroplasty with extensive coated femoral component. J Arthroplasty 1996;11:981-8.
40. Incavo SJ, Beard DM. One-stage revision of periprosthetic fractures around loose total hip arthroplasty. Am J Orthop 1998;27:35-41.
41. Mont MA, Maar DC. Fractures of the ipsilateral femur after hip arthroplasty. J Arthroplasty 1994;9(5):511-9.
42. Mauri AC, Pressman A, Gross A. Proximal femoral allograft treatment of Vancouver type B3 periprosthetic femoral fractures after total hip arthroplasty. J Bone Joint Surg Am 2006;88:953-8.