CEMENT-IN-CEMENT STEM REVISION FOR VANCOUVER TYPE B PERIPROSTHETIC FEMORAL FRACTURES AFTER TOTAL HIP ARTHROPLASTY

Abstract

20 Vancouver type B periprosthetic femoral fractures were treated in our unit by cementing a revision stem into the pre-existing cement mantle following fracture reduction. The technique was used in elderly, multiply co-morbid patients with the intention of reducing operative time and peri-operative complications.

3 patients died in the first 3 months from reasons not related to surgery, with no recorded evidence of fracture healing and were excluded from the study and 1 was too frail to attend follow up. The remaining 16 cases were followed up for a mean of 3 years. The mean time to radiological union was 5 months (range: 2–11) and the mean time to clinical union was 4.9 months (range: 2–17). The mean Modified Harris Hip Score in these patients was 66.5 (range: 35.2–97). One patient had further surgery for a delayed union and there was one failure of fixation. The mean hospital stay was 10.8 days and the mean time to fully weight bear 38.1 days.

This study suggests that there is a valid role for the use of the in-cement revision technique in Vancouver type B periprosthetic femoral fractures in a highly selected group of elderly patients unsuitable for lengthy reconstructive procedure