Periprosthetic fractures around cementless hydroxyapatite-coated femoral stems

We studied 14 periprosthetic femoral fractures out of a series of 619 hydroxyapatite coated hip implants and compared the outcome to published treatment algorithms using the Vancouver classification. There were five type A fractures, six B1, two B2, and one type B3 fracture. All but one type A fractures were treated conservatively. Compared with the Vancouver classification, we observed a different fracture type in the type B fractures. No fractures at the tip of the stem were seen, as in cemented implants. Three B1 fractures were treated operatively due to fracture displacement, and three were treated conservatively. The B2 and B3 fractures were managed with long, uncemented, revision stems because of a disrupted bone-prosthesis interface. All fractures healed well. This study confirms that the modified algorithm of management of periprosthetic fractures, using the Vancouver classification, is a simple, reproducible, classification system for uncemented prostheses. Conservative treatment is a valid option if the implant is stable whilst surgical intervention is mandatory if the implant is loose.