To evaluate respectively the clinical results after femoral stem exchange or retention in the treatment of Vancouver B2, B3 periprosthetic femoral fractures.

Nineteen cases of Vancouver B2 fractures and 8 cases of B3 fractures that were treated surgically between January 1992 to October 2004 were reviewed. There were 15 retained stems (group A) and 12 exchanged stems (group B). Firm fixation of a fracture and stem with a plate, screw and cable was performed in both groups. The HHS and criteria of Beals and Tower was used for the clinical and radiological evaluation.

The mean HHS was 84 in group A and 85 in group B. Unsatisfactory (<80 HHS) results were obtained in 2 cases from each group. The radiological results were excellent in both groups with the exception of one case of femoral stem loosening in group A and one case of non-union in group B. The complications encountered were 1 case of femoral stem loosening, 1 case of non-union, 1 case of a superficial infection, 1 case of dislocation, and 1 case of cup loosening.

Stable fixation of the fracture and stem with a sufficient bone graft in the treatment of Vancouver B2, B3 periprosthetic femoral fractures can produce favorable clinical results regardless of the level of femoral exchange.