Uncemented fully porous-coated long femoral stem prosthesis for management of Vancouver type B2 periprosthetic femoral fracture

Objective To evaluate the clinical results of uncemented fully porous-coated long femoral stems in treating Vancouver type B2 periprosthetic femoral fracture following hip arthroplasty. Methods A retrospective analysis was made on 12 patients (12 hips) with Vancouver type B2 periprosthetic femoral fracture treated using the uncemented fully porous-coated long femoral stem prosthesis combined with cerclage fixation with steal-wire or titanium cable devices from February 2006 to January 2013. There were 5 males and 7 females, aged average 69.8 years (range, 62 to 79 years). The status of primary arthroplasty was uncemented bipolar hemiarthroplasty in 2 patients and total hip arthroplasty in 10 patients (2 cement and 8 cementless femoral stems). At the final follow-up, Harris hip score for clinical evaluation, Beals and Tower's criteria for radiological evaluation, and complications were recorded. Results There were no intra-operative complications such as femoral perforation and femoral fracture. All patients were followed up for mean 38 months (range, 24-72 months). At the last follow-up, mean Harris hip score was 87.2 points (range, 50 to 100 points). All fractures healed at average 16 weeks (range, 12-28 weeks). All the 12 hips showed prosthesis stability despite there was one femoral stem subsidence of 3 mm. One patient slipped and sustained another periprosthetic fracture (Vancouver type B1) at postoperative 4 months and was treated successfully with locking plate and cables. According to the Beals and Tower's criteria, there were 10 excellent, 1 good and 1 poor results. Final follow-up revealed no complications of deep vein thrombosis, dislocation and prosthesis loosening. Conclusion Uncemented fully porous-coated long femoral stems provide good primary stability that promotes fracture healing and offers a reasonable treatment of Vancouver B2 femoral periprosthetic fracture. Key words: Femoral neck fractures; Arthroplasty, replacement, hip; Periprosthetic fractures