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

Abstract

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.