Revision Arthroplasty in Vancouver B1 Periprosthetic Hip Fractures



Arthroplasty, Replacement, Hip, Periprosthetic Fractures/diagnosis, Periprosthetic Fractures/surgery, Postoperative Complications, Reoperation


Introduction: Periprosthetic hip fractures (PHF) represent an important complication after hip arthroplasty. The management of Vancouver B1 fractures remains elusive. While most stems may present radiographically as stable, stem fixation may in fact be compromised. Choosing plate osteosynthesis as a treatment in this type of fractures, trusting radiographic studies alone may lead to implant failure.
Methods: We reviewed 10 years of our institution ́s clinical records (2011­2021) and found a total of 161 PHF. Twenty five cases of B1 periprosthetic fractures were included in our study, after their presenting radiographs were blindly reviewed. All PHFs were submitted to arthrotomy, dislocation and stability assessment. Stable implants were submitted to plate osteosynthesis, and unstable implants were submitted to revision arthroplasty. Demographic information, duration of surgery, blood loss, inpatient complications, functional outcomes, and outpatient outcomes and complications were recorded. Mean time of follow­up was 47 months.
Results: Seventy­two percent of of initially classified B1 type fractures presented with a loose stem and required revision arthroplasty. Time until supported ambulation was lower in the revision arthroplasty group (p= 0.01) while surgical time, blood loss after surgery, and inpatient complications presented similar results in both groups. Negative outpatient outcomes showed similar rates in both groups.
Conclusion: Most radiographically well­fixed implants were in fact unstable. Stability assessment using radiographic studies alone proves insufficient and may lead to inadequate osteosynthesis treatment. As such, in­operative stability testing in all B1 type fractures is paramount. Revision arthroplasty permitted early ambulation and showed no greater complications when comparing with osteosynthesis.


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Revision Arthroplasty in Vancouver B1 Periprosthetic Hip Fractures. (2024). Orthopaedic SPOT, 1(2), 86-92.

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