Femoral Stem Revision for Vancouver type B2 and B3 Periprosthetic Fractures

Yoon Jae Seong; Won Chul Shin; Hyung Joon Cho; Jung Sub Lee; Kuen Tak Suh

doi:10.4055/jkoa.2013.48.3.197

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Seong, Shin, Cho, Lee, and Suh: Femoral Stem Revision for Vancouver type B2 and B3 Periprosthetic Fractures

Original Article

Journal of the Korean Orthopaedic Association 2013; 48(3): 197-204.

Published online: 24 June 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.3.197

Femoral Stem Revision for Vancouver type B2 and B3 Periprosthetic Fractures

Yoon Jae Seong, M.D, Won Chul Shin, M.D, Hyung Joon Cho, M.D, Jung Sub Lee, M.D, Kuen Tak Suh, M.D

Department of Orthopaedic Surgery, Pusan National University School of Medicine, Yangsan, Korea.

Correspondence to: Kuen Tak Suh, M.D. Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea. TEL: +82-55-360-2125, FAX: +82-55-360-2155, kuentak@pusan.ac.kr

Received 17 January 2013 Revised 7 March 2013 Accepted 17 March 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We evaluated the outcome of femoral stem revision for Vancouver B2 and B3 periprosthetic femoral fractures.

Materials and Methods

We conducted a retrospective assessment of 15 patients who had received treatment for a periprosthetic unstable femoral fracture after primary hip arthroplasty between May 1997 and September 2009. According to Vancouver classification, 11 patients were type B2 and four were B3. Open reduction and long stem revision were performed in all 15 cases. In Vancouver type B3 fractures, we treated patients with open reduction and long stem revision with an allogenic cancellous bone graft, which is the same as in that used in Vancouver type B2 fractures. An allogenic onlay cortical bone graft was used when additional stability was required. The mean age of patients was 67.1 years at the time of surgery and the mean duration of follow-up was 31.5 months. We described the clinical and radiographic results.

Results

Using Beals and Tower's criteria, fair to good clinical and radiologic results were observed at the latest follow up, with an average Harris hip score of 94.4 points. Fractures were united in all 15 patients. One patient had non-union of the greater trochanter of the femur, one patient had superficial infection, and one patient had non-union of onlay bone graft, however, there were no further complications, such as dislocations, periprosthetic infections, or nerve injuries. There was no loosening of the femoral stems.

Conclusion

In Vancouver type B2 and B3 fractures, when there is loosening of the femoral stems, open reduction and long stem revision with allogenic cancellous bone graft provided a satisfactory result. However, long-term follow up is needed.

Keywords: femur, periprosthetic fractures, Vancouver classification, surgical revision

Figures and Tables

Figure 1

Vancouver type B2 fracture: stem revision with onlay bone graft. Radiographs of a 74-year-old female with a Vancouver type B2 fracture. (A) The post-traumatic radiographs. The femoral stem had been sunken down remarkably. The fracture pattern was unstable; oblique fracture line with butterfly fragment. This patient had relatively fair bone stock. (B) The immediate postoperative radiographs. Supplementary fixation anterior to the fracture site with onlay bone graft and cables were needed. An extensively porous coated curved stem (8 inches, Solution, Depuy) was used. (C) The radiographs at the latest follow-up. Eight years after the operation, fracture was healed and the graft was successfully integrated.

Figure 2

Vancouver type B3 fractures. Radiographs of a 78-year-old male with a Vancouver type B3 fracuture. (A) The post-traumatic radiograph. A cemented stem was used at primary total hip replacement. The femoral stem had been sunken down remarkably with a fracture of the cement mantle. Note that the bone stock was mostly absent between the cortex and stem with severe cortical thinning preoperatively. (B) The immediate postoperative radiographs. We applied a massive cancellous impaction bone graft surrounding the extensively porous coated curved stem (10 inches, Solution, Depuy). (C) The radiographs at latest follow-up. Twelve months after the operation, the fracture was healed and bone formation was observed at the proximal femur.

Table 1

Patient Demographics

Values are presented as number or average (range).

Table 2

Types of Stem by Vancouver Classification

Table 3

Radiologic and Clinical Outcomes

Values are presented as number or average (range).

Table 4

Union of Fracture Site and Other Complications

Notes

This study was supported by a voluntary assignment research (2 years) grant from Pusan National University.

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