Outcomes of Vancouver B2 and B3 periprosthetic femoral fractures after total hip arthroplasty in elderly patients

Introduction: The objective was to evaluate clinical and radiological outcomes of Vancouver B2 and B3 periprosthetic femoral fractures in patients older than 65 years treated at our institution from 2000 to 2014. We compared the most common methods of fixation: a modular tapered rectangular titanium stem versus a monoblock tapered stem. Methods: A retrospective review was performed with a minimum follow-up time of 2 years. Patient mobility in the period prior to the fracture and after fracture healing and functional results was assessed according to the Harris Hip Score. Results: A total of 43 Vancouver B2 and B3 periprosthetic fractures fulfilled the inclusion criteria (31 type B2 and 13 type B3). The mean age was 78 years old (66–88 years). The mean follow-up time was 5 years (range 2–12 years). A Wagner stem was used in 19 patients and a modular rectangular stem was implanted in 24 patients. Although fracture union was achieved in 93% of the cases, the mean Harris Hip Score was 73 (34–87) and 41.9% of the patients did not return to their previous ambulatory levels ( p = 0.0049). Dislocation was the most common complication (16.3%). We have found association ( p = 0.07) between subsidence with a mean of 4.14 mm and dislocation. No difference was observed between B2 and B3 fractures or between modular and monoblock stems. Discussion: Although we reported good results of fracture healing, there were functional impairment and a high rate of complications, especially dislocation, in Vancouver B2 and B3 periprosthetic fractures in elderly patients.

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Osteosynthesis and outcomes of traumatic periprosthetic femoral fractures after total hip arthroplasty

Arthroplasty ◽

10.1186/s42836-021-00089-1 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Ali Taha ◽

ElZaher Hassan ElZaher ◽

Ibrahim ElGanzoury ◽

Mostafa Ashoub ◽

Amr Khairy

Keyword(s):

Total Hip Arthroplasty ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Open Reduction ◽

Femoral Fractures ◽

Harris Hip Score ◽

Total Hip ◽

Periprosthetic Femoral Fractures ◽

The Mean

Abstract Purpose The aim of this retrospective study was to investigate the treatment of traumatic periprosthetic femoral fractures with open reduction and internal fixation. The outcomes with the use of the surgical techniques were also reported. Methods Between September 2017 and September 2019, 25 patients with traumatic periprosthetic femoral fractures were managed by open reduction and internal fixation in Ain Shams University Hospital, Egypt. The fixation methods were selected based on the surgeon’s preference. Outcomes were assessed using the Harris Hip Score, visual analogue score (VAS) for pain, and EuroQol 5 Dimensions – 5 Level (EQ5D-5L) prior to and after surgery. Patients were regularly followed up for one year. A P value < 0.05 was considered to be statistically significant. Results The mean age at surgery was 77 years (range, 51 to 95 years), 64% (n = 16) were females. According to the Vancouver classification, there were 1 type AG, 15 type B1, and 9 type C fractures. Postoperative complications included wound site infection (n = 2) and non-union (n = 1). The mean pre-trauma Harris Hip Score was 77.44 ± 8.63 (range, 65 to 90), and the mean Harris Hip Score collected at the final follow-up was 72.47 ± 8.85 (range, 60 to 86) (P < 0.05). The mean pre-trauma VAS was 2.20 ± 1.21 (range, 0 to 4), and the mean VAS recorded at the final follow-up was 3.00 ± 1.41 (range, 0 to 5) (P < 0.05). According to the EQ5D-DL assessed at the final follow-up, no patient felt that their daily life and activities became more problematic. Conclusion This study provided added validation of the current management of periprosthetic femoral fractures after total hip arthroplasty. Using the proper fixation and implant can achieve a reliable fixation and good functional recovery. Level of evidence IVa

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Controlled femoral cracking for reduction of hip arthroplasty in high riding hips: Is it safe?

10.21203/rs.3.rs-109533/v1 ◽

2021 ◽

Author(s):

Yüksel Yaradılmış ◽

Mustafa Okkaoğlu ◽

Erdi Özdemir ◽

Ahmet Ateş ◽

İsmail Demirkale ◽

...

Keyword(s):

Hip Arthroplasty ◽

Operating Time ◽

Functional Results ◽

Limb Length Discrepancy ◽

Femoral Osteotomy ◽

Harris Hip Score ◽

Additional Procedure ◽

The Mean ◽

Retrospective Examination

Abstract Background: As subtrochanteric femoral osteotomy extends the operating time and increases bleeding, it is a complex surgical procedure, which exposes the patient to complications. The aim of this study was to describe the controlled femoral cracking method as a safely reduction method and to present the results of this method used in hip arthroplasty without femoral osteotomy in high dislocated hip.Methods: A retrospective examination included 40 Crowe III/IV patients for whom shortening was not planned preoperatively. Femoral osteotomy was planned for Crowe III/IV patients who were expected to have >4cm lengthening according to the preoperative templating. Patients were evaluated in respect of functional results, limb length discrepancy (LLD) and complications. Of the 40 patients applied with surgery without shortening, controlled femoral cracking was required in 20 cases, and no additional procedure was required during reduction in 20 cases. The patients applied with controlled femoral cracking were evaluated in respect of functional results, operating time, actual LLD and complications.Results: The patients comprised 3 males and 37 females with a mean age of 53.7±9.54 years. The mean follow-up period was 38±6.54 months (range, 24-66 months). The Harris Hip Score (HHS) was mean 45.96 preoperatively and 89.44±6.4 (range, 84-99) postoperatively. LLD was determined as 3.4±0.7cm preoperatively and 0.7±0.5 cm (range, 0-2 cm) postoperatively (p<0.05). The final HHS was 88.2±6.3 in patients applied with controlled femoral cracking and 90.3±6.5 (range, 86-99) in those not applied with controlled femoral cracking (p=0.740). No increase in complications was observed in the patients applied with controlled femoral cracking.Conclusion: In patients where more than 4 cm of lengthening is not expected preoperatively, arthroplasty can be successfully managed without a shortening femoral osteotomy. The controlled femoral cracking technique is safe, does not increase LLD or nerve palsy rate, and shortens operating time with less blood loss.

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Periprosthetic Femoral Fractures Treated with a Modular Distally Cemented Stem

Journal of Orthopaedic Surgery ◽

10.1177/230949900701500207 ◽

2007 ◽

Vol 15 (2) ◽

pp. 163-166 ◽

Cited By ~ 5

Author(s):

SH Zaki ◽

S Sadiq ◽

B Purbach ◽

BM Wroblewski

Keyword(s):

Hip Arthroplasty ◽

Femoral Fractures ◽

Healing Time ◽

Revision Hip Arthroplasty ◽

Harris Hip Score ◽

Bone Stock ◽

Non Union ◽

Periprosthetic Femoral Fractures ◽

Cemented Stem ◽

The Mean

Purpose. To assess the treatment outcome of revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures using a modular distally cemented stem. Methods. 22 men and 14 women (37 hips) aged 66 to 79 (mean, 70) years underwent revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures. The indication for surgery was periprosthetic fracture with stem loosening and loss of proximal bone stock. The patients were referred from other hospitals after previous surgeries had failed: 8 with 3 previous surgeries, 19 with 2, and 9 with one. Using a transtrochanteric approach, the existing prosthesis was removed and a modular proximal femoral replacement stem was inserted, bypassing the area of proximal femoral fracture and bone loss. The stem was distally cemented. Patients were immobilised within 48 hours of surgery. Results. Patients were followed up for a mean of 14 (range, 8–18) years. The mean Harris hip score improved from 29 (range, 5–40) to 78 (range, 56–88); 24 patients attained excellent or good scores (>80), 10 attained fair, and 2 attained poor scores. The mean healing time was 7 (range, 6–14) months; there was no non-union. Improvement in proximal bone stock was noted on serial radiographs. None of the stems had cement fracture or migration, requiring revision. Two (5%) of the patients had dislocations. Conclusion. Vancouver type B3 periprosthetic femoral fractures can be successfully treated with a distally cemented modular proximal femoral replacement prosthesis.

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Minimally Invasive Management of Unstable Proximal Femoral Extracapsular Fractures using Reverse LISS Femoral Locking Plates

Hip International ◽

10.1177/112070000901900211 ◽

2009 ◽

Vol 19 (2) ◽

pp. 141-147 ◽

Cited By ~ 12

Author(s):

Ufuk Ozkaya ◽

Fuat Bilgili ◽

Ayhan Kilic ◽

Atilla Sancar Parmaksizoglu ◽

Yavuz Kabukcuoglu

Keyword(s):

Treatment Options ◽

Femoral Fractures ◽

Deep Infection ◽

Harris Hip Score ◽

Proximal Femoral Fractures ◽

Medical Problems ◽

Secondary Procedures ◽

The Mean ◽

Invasive Management

The efficacy of the reverse Less Invasive Plating System in the management of unstable proximal femoral extracapsular fractures was retrospectively evaluated. Twenty-seven patients with complex proximal femoral fractures were identified. There were three open fractures. The mean age was 71 years (range; 65–79). The mean follow up was 24 months (range; 15–32). The main outcome measures were union, union time, requirement for secondary procedures, development of deep infection, pain, and functional impairment. Nonunion was observed in one patient. The average Harris hip score at the last assessment was 73 points (range 58–85). The outcome was adversely affected by concomitant medical problems, anatomical reduction and fixation of the plate. The use of this plate in the management of proximal femoral fractures of all types may be a safe and alternative method to other treatment options.

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Cable plating with a single strut allograft in the treatment of periprosthetic fractures of the femur

Hip International ◽

10.1177/1120700018761519 ◽

2018 ◽

Vol 29 (1) ◽

pp. 58-64 ◽

Cited By ~ 2

Author(s):

Jonathan R Manara ◽

John A Mathews ◽

Harvey S Sandhu

Keyword(s):

Plate Fixation ◽

Periprosthetic Fractures ◽

Harris Hip Score ◽

Complication Rates ◽

Reproducible Method ◽

The Mean ◽

Modified Harris Hip Score ◽

Unified Classification System ◽

Hip Arthroplasties

Background: Hip arthroplasties are increasing worldwide resulting in an increasing number of periprosthetic fractures. These fractures are difficult to treat with various the different fixation or revision options described, many of which have high complication rates. Purpose: To investigate whether our described method of treating periprosthetic fractures is an effective, safe and reproducible method of treating patients. Methods: We describe the largest series of a cable plate fixation system combined with a single cortical strut allograft to treat patients with periprosthetic fractures of the hip (Unified Classification System B1 and selected B2, C and D). Results: Between July 2006 and March 2015, 28 patients were treated using this method. The mean follow-up was 2.2 years (3 months to 9 years). The mean Oxford Hip Score (OHS) at final follow-up was 32 and the mean modified Harris Hip Score (mHHS) 67. There were 3 complications including 1 failure that required revision surgery, 1 case of infection successfully treated with debridement, antibiotics and retention, and a case of discomfort from the metalwork which we managed conservatively. Conclusion: This method of anatomical restoration of the femur with dual-plane fixation is a highly effective method of treating this complex group of patients, and should be considered as a first line of treatment. It shows that there is a role for successful treatment with internal fixation of certain B2, C and D fractures with this technique.

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The Biological Metallic versus Metallic Solution in Treating Periprosthetic Femoral Fractures: Outcome Assessment

Advances in Medicine ◽

10.1155/2016/2918735 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Serafino Carta ◽

Mattia Fortina ◽

Alberto Riva ◽

Luigi Meccariello ◽

Enrico Manzi ◽

...

Keyword(s):

Short Form ◽

Evaluation Criteria ◽

Femoral Fractures ◽

Metal Plate ◽

Harris Hip Score ◽

Periprosthetic Femoral Fractures ◽

Sf 36 ◽

Complications And Mortality

Introduction. The periprosthetic fracture of the femur is, in order of frequency, the fourth leading cause (5.9%) of surgical revision. Our study aims to demonstrate how the grafting of bone splint betters the outcomes.Materials. We treated 15 periprosthetic femoral fractures divided into two groups: PS composed of 8 patients treated with plates and splints and PSS involving 7 patients treated only with plates. The evaluation criteria for the two groups during the clinical and radiological follow-up were the quality of life measured by the Short Form (36) Health Survey (SF-36), Harris Hip Score (HHS), Modified Cincinnati Rating System Questionnaire (MCRSQ), bone healing measured by the Radiographic Union Score (RUS), postoperative complications, and mortality. The evaluation endpoint was set at 24 months for both groups (p<0.05).Results. The surgery lasted an average of 124.5 minutes for the PS group and 112.6 minutes for the PSS. At 24 months all clinical and radiographic scores werep<0.05for the PS group. During follow-up 4 patients (2 in each group) died of causes not related to surgery.Conclusions. The use of the metal plate as opposed to cortical allogenic splint should be taken into consideration as a noteworthy point for periprosthetic femoral fractures.

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Salvage Total Hip Replacement after Failed Internal Fixation of Trochanteric Fracture Femur.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v5i1.163 ◽

2021 ◽

Vol 5 (1) ◽

pp. 751-757

Author(s):

Vilson Ruci ◽

Edvin Selmani ◽

Agron Dogjani

Keyword(s):

Internal Fixation ◽

Total Hip Replacement ◽

Hip Replacement ◽

Femoral Fractures ◽

Harris Hip Score ◽

Salvage Procedure ◽

Bone Stock ◽

Total Hip ◽

The Mean

Background: Total hip replacement (THR) is one treatment option for failed hip fracture fixation. It is considered as a salvage procedure for older patients, patients with poor bone stock, avascular necrosis of the femoral head, associated with damaged acetabular articular cartilage. Patients and Methods: Total hip replacement was done for forty patients with failed internal fixation of trochanteric femoral fractures, 28 males and 12 females completed the follow up and six patients were lost. The procedure was carried out through a lateral exposure in all cases. Harris hip score (HHS) was used for clinical evaluation preoperatively, postoperatively. Radiographic evaluation comprising anteroposterior radiographic views of the pelvis and femur and a lateral view of the femur were performed at follow-up visits. Results: The mean time of follow up was 48 months (range from 36-72 months). The mean Harris hip score was improved from a mean of 24 points preoperative to 88 points at final follow up. Pain relief and gait correction were noted at the final follow up. Twenty-eight patients (70%) could freely walk outdoors using a cane or elbow crutch; eight patients (20 %) had a limited walking ability using two axillary crutches, and four patients (10 %) were able to walk indoors only. Conclusion: Total hip arthroplasty is a good salvage procedure after failed internal fixation of trochanteric femoral fractures. Individual selection of the implant depends upon the age of patient, level of activity, the bone stock of proximal femur, and the condition of the acetabulum. To maintain stability, reattachment of the greater trochanter should be done. To avoid intraoperative fractures of osteoporotic bone, dislocation of the hip should be very careful.

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Hemiarthroplasty for intra-capsular fracture neck of femur in elderly patients: a prospective observational study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173119 ◽

2017 ◽

Vol 3 (5) ◽

pp. 991

Author(s):

Abhishek Kalantri ◽

Sunil Barod ◽

Dilip Kothari ◽

Archana Kothari ◽

Ashok Nagla ◽

...

Keyword(s):

Elderly Patients ◽

Road Traffic ◽

Excellent Result ◽

Operative Procedure ◽

Functional Results ◽

Harris Hip Score ◽

Neck Of Femur ◽

Mortality And Morbidity ◽

Fracture Neck Of Femur

Background: Hip fractures in older patients are associated with impaired mobility, excess morbidity and mortality, and loss of independence. This study was aimed at evaluating the outcome of hemiarthroplasty, by assessing the quality of life and degree of function in the operated limb.Methods: Out of 30 patients treated in this manner, all cases were available for follow-up period of 6 months. Patients of age 60 years and above, diagnosed with fracture neck of femur, were included in the study.Results: Majority of patients belongs to age group 60-69 years was 56.7% Females were more common 56.7% than males in the present study. About 13.3% patients sustained the injury due to a fall from a height and 23.3% due to a road traffic accident. About 20 patients (60%) had a stay of less than 20 days in hospital. In our study Harris hip score, at end of six month ranged from 35 to 94.6. At final 6 months follow-up by Harris hip scoring system, 53.33% had excellent result, 33.3% had good results, 16.67% had fair results and 6.67% had poor results. Conclusions: We conclude that hemiarthroplasty for fracture neck of femur is a good option in elderly patients. The mortality and morbidity are not high, operative procedure is simple, complications are less disabling. Early functional results are satisfactory.

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Fractures of the Distal End of Radius in Elderly Patients: A Comparative Study of Anatomical and Functional Results

Journal of Orthopaedic Surgery ◽

10.1177/230949900201000103 ◽

2002 ◽

Vol 10 (1) ◽

pp. 9-15 ◽

Cited By ~ 44

Author(s):

Koji Fujii ◽

Tatsuhiko Henmi ◽

Yoshiji Kanematsu ◽

Takuya Mishiro ◽

Toshinori Sakai ◽

...

Keyword(s):

Retrospective Study ◽

Elderly Patients ◽

Subjective Evaluation ◽

Functional Results ◽

Radius Fractures ◽

Radiographic Evidence ◽

Satisfactory Outcome ◽

The Mean ◽

Grip Power

The functional and anatomical results of distal end of radius fractures with severe displacement in 22 elderly patients are reviewed in this retrospective study. The mean age of the patients was 69.4 years (range, 60–88 years) and the mean follow-up period was 24 months (range, 12–53 months). According to the sum of demerit points (Saito, 1983), the latest follow-up functional end results were ‘excellent’ in 64% of fractures and ‘good’ in 36%. As for the anatomical results at follow-up, the average radial tilt was 20.7°, ulnar variance was 4.0 mm, and palmar tilt was −2.7° respectively. Though most of the patients had satisfactory outcome and the functional results did not correlate with the radiographic evidence of minor deformities, the functional results of the patients with radial shortening of 6 mm or over were poor. Furthermore, the grip power was the most significant factor related to subjective evaluation and did not improve significantly in patients with the nondominant hand injured.

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Midterm follow-up with modular fluted tapered stem in the management of Vancouver B3 femoral periprosthetic fracture

10.21203/rs.3.rs-17450/v1 ◽

2020 ◽

Author(s):

Qi Cheng ◽

Li Zheng ◽

Yunzhi Ding ◽

Fengchao Zhao

Keyword(s):

Periprosthetic Fracture ◽

Femoral Stem ◽

Good Choice ◽

Lower Limbs ◽

High Rate ◽

Harris Hip Score ◽

Bone Stock ◽

Stem Subsidence ◽

The Mean

Abstract BackgroundTo evaluate the technique and clinical results of the uncemented fluted, tapered, modular stems in treating Vancouver B3 periprosthetic femoral fractures. MethodsA retrospective study was carried out on 56 patients (56 hips) with the use of the modular femoral stem in revision of total hip arthroplasty between August 2007 and January 2009. The mean patient age was 73.4±6.6 years(rang, 62-82years). Bone defect was categorised as Paprosky types：32 Type IIIA , 20 Type IIIB, 4 Type Ⅳ. 28 hips had allograft struts placed around the fracture. 44 patients had concomitant revision of the acetabular component. The mean duration of follow-up was 102.1±12.2 months (rang, 84-120 months). Hip function and treatment outcome were assessed using Harris Hip Score System and Beals and Tower 's standard. Radiography were used to evaluate the implant stability, bone stock restoration, fracture healing, stem subsidence and complications. ResultsThe mean HHS improved from 45.6 ±5.4 points (range, 32-53 points) preoperatively to 86.3±8.4 points (range, 81-92 points) at the most recent follow-up. Radiographic review showed all fractures of patients united, with maintenance or improvement of bone stock in 96% of patients. The average value of the stem subsidence 4.9±1.5mm (rang, 0-9mm), happening mainly within the first six months after the operation. No implant had been revised because of aseptic loosening or dislocation. 8 of all the 28 allografts united to the host bone. In the last follow-up, 20 cases of treatment results were excellent, 36 cases were good. There were four patients occuring complications such as deep vein thrombosis of lower limbs or subcutaneous haematomas after surgery, all cured during hospitalization. There were no patients occurring the dislocation of hips after revision. ConclusionThe uncemented fluted, tapered, modular prosthesis is a good choice with a high rate of fracture union and implant osteointegration when the treatment of the Vancouver B3 femoral periprosthetic fracture.

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