Locking compression plate versus revision-prosthesis for Vancouver type B2 periprosthetic femoral fractures after total hip arthroplasty

• Published in: Injury Vol. 47; no. 4; pp. 939 - 943
• Main Authors: Joestl, Julian, MD, Hofbauer, Marcus, MD, Lang, Nikolaus, MD, Tiefenboeck, Thomas, MD, Hajdu, Stefan, MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-04-2016
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Bone Plates; Female; Femoral Fractures - diagnostic imaging; Femoral Fractures - physiopathology; Femoral Fractures - surgery; Femoral Stem Loosening; Fracture Fixation, Internal; Fracture Healing; Humans; Locking Compression Plate (LCP), Revision Arthroplasty; Male; Orthopedics; Periprosthetic fractures; Periprosthetic Fractures - diagnostic imaging; Periprosthetic Fractures - physiopathology; Periprosthetic Fractures - surgery; Radiography; Reoperation; Total hip arthroplasty (THA); Treatment Outcome; Vancouver B2; Periprosthetic fractures; Total hip arthroplasty (THA); Locking Compression Plate (LCP), Revision Arthroplasty; Vancouver B2; Femoral Stem Loosening
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2016.01.036

Abstract Introduction Revision arthroplasty is currently the recommended treatment for periprosthetic femoral fractures after primary total hip arthroplasty (THA) and stem loosening (Vancouver B2). However, open reduction and internal fixation (ORIF) utilizing locking compression plate (LCP) might be an effective treatment with a reduced surgical time and less complex procedure in a typically elderly patient collective with multiple comorbidities. The purpose of this study was to compare the functional and radiographic outcomes in two cohorts with Vancouver B2 periprosthetic femoral fractures after primary THA, treated either by ORIF with LCP fixation, or by revision arthroplasty utilizing a non-cemented long femoral stem. Materials and Methods 36 patients with Vancouver B2 periprosthetic femoral fractures following THA, who had been treated between 2000 and 2014, were reviewed. Eight fractures were treated with LCP fixation, fourteen fractures with the first-generation revision prosthesis (Helios® ), and fourteen fractures with the second-generation revision prosthesis (Hyperion™). The patients were assessed clinically with the Parker mobility score and radiographically. Results A total of ten males and 26 females formed the basis of this report with an average age of 81years (range, 64 to 96 years). All fractures treated with LCP fixation alone healed uneventfully and there were no signs of secondary stem migration, malalignement or plate breakage. The average surgical time was shorter in the ORIF cohort; however, the results were not statistically significant. The postoperative Parker mobility score at latest follow-up showed no difference between the groups. Conclusions According to the results of the current study, we conclude that the use of LCP fixation can be a sufficient option for the treatment of Vancouver B2 periprosthetic femoral fractures correspondingly with femoral stem loosening.