Related Experiment Video
Updated: Jul 30, 2026
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Periprosthetic fractures around cemented hip hemiarthroplasty: Are SOFCOT-Vancouver recommendations mandatory? A
Galdéric Roblot1, Julien Demester1, Benoit Brunschweiler1
1Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 1 rond-point du Pr Cabrol, 80054 Amiens Cedex, France.
Insights
Osteosynthesis is a reliable option for periprosthetic hip fractures (PPF) around hemiarthroplasties, showing similar complication rates to revision surgery but with shorter operative times and hospital stays. This approach preserves patient autonomy and is suitable for elderly patients with multiple comorbidities.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Trauma Surgery
Background:
- Periprosthetic hip fractures (PPF) are serious complications following hip hemiarthroplasty (HHA), often leading to increased mortality and reduced patient autonomy.
- Standard treatment for loosened implants involves prosthetic revision, but fixation without exchange is emerging as a viable alternative, particularly for frail elderly patients.
Purpose of the Study:
- To compare postoperative complications between osteosynthesis and prosthetic revision in elderly patients with Vancouver B fractures around polished tapered stem hemiarthroplasties.
- To investigate the efficacy and safety of osteosynthesis as an alternative to revision surgery for PPF in a French cohort.
Main Methods:
- A retrospective comparative study included 92 elderly patients (average age 88.7 years) with PPF after cemented hemiarthroplasty.
- Patients were treated with either osteosynthesis or prosthetic revision.
- The primary outcome was a composite of reintervention or death within one month postoperatively. Propensity score matching was used for group comparability.
Main Results:
- No significant difference was observed in the primary outcome between osteosynthesis (48.71%) and revision (41.02%) groups (p=0.637).
- Osteosynthesis showed significantly shorter operative times, reduced blood loss, shorter hospital stays, and better autonomy preservation compared to revision surgery.
- The 1-year mortality rate was 29.3%, and the reintervention rate was 27.2%, with dislocations and infections being the main causes.
Conclusions:
- Osteosynthesis is a reliable option for Vancouver B periprosthetic hip fractures when the fracture is reducible and the cement mantle is intact.
- This approach offers advantages in terms of surgical time, blood loss, hospital stay, and functional recovery, supporting its use in selected elderly patients.
- The findings suggest adapting Vancouver-SOFCOT recommendations to include osteosynthesis for HHA PPF.
Introduction:
Periprosthetic hip fracture is a serious complication associated with increased mortality and impaired autonomy. When the implant is loosened, the standard treatment involves prosthetic revision. However, recent studies suggest that these cases can be successfully treated with fixation without prosthetic exchange. This strategy seems relevant for elderly and frail patients with fractures around hemiarthroplasties but it has not yet been investigated in France. Therefore we did a retrospective comparative investigation aiming to compare postoperative complications (i.e., death within one month or reintervention) between osteosynthesis and prosthetic revision in elderly patients with Vancouver B fractures around polished tapered stem hemiarthroplasties.
Hypothesis:
We hypothesized that there would be no significant difference between osteosynthesis and prosthetic revision.
Materials And Methods:
In a single-university-center, all patients treated between 2005 and 2024 for periprosthetic fractures after cemented hemiarthroplasty were included in a retrospective observational study. A total of 92 patients were included, with an average age of 88.7 years (range, 77-107), mostly institutionalized (58%) and with multiple comorbidities, as indicated by a mean ASA score of 2.75 (range: 2-4) and a mean Charlson Comorbidity Index of 6.4 (range: 4-10); the average time between HHA and PPF occurrence was 2.1 years (range: 7-5679 days). The primary outcome was a composite criterion including the occurrence of a complication requiring reintervention or death within one month postoperatively. Group comparability was established using a propensity score.
Results:
The mean follow-up was 665 days, with the longest follow-up reaching 5704 days. No significant difference was observed in the primary outcome between the osteosynthesis group (n = 19/39 patients, (48.71%)) and the revision group (n = 16/39 patients, (41.02%)) (p = 0.637). Osteosynthesis demonstrated significantly shorter operative time (96 min vs. 167 min, p < 0.001), reduced blood loss (428 mL vs. 874 mL, p < 0.001), shorter hospital stays (9.17 days vs. 13.39 days, p < 0.001), and better autonomy preservation (loss of 1.09 Parker score points vs. 1.97 points, p < 0.001) compared to revision surgery. The 1-year mortality rate was 29,3% (27/92). The reintervention rate was 27.2% (25/92). The main causes of reintervention were dislocations, accounting for 13% (12/92) of cases, (occurring in 9.4% (5/53) of patients in the osteosynthesis group and 17.9% (7/39) in the revision group. The second most common reintervention cause was infection, which accounted for 11% (10/92) of cases, (occurring in 7.5% (4/53) of patients in the osteosynthesis group and 15.4% (6/39) in the revision group).
Discussion:
This result supports the idea that, for HHA's PPF, the Vancouver-SOFCOT recommendations can be adapted. For all type B fractures, if the fracture can be reduced and the cement mantle is well-fixed to the bone and of good quality, osteosynthesis is also a reliable option.
Level Of Evidence:
III; Retrospective comparative study.
More Related Videos
07:45The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report
Published on: August 4, 2022
09:51The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
