Vancouver B Fractures After Using Cementless Femoral Fixation: A Single Center Experience

Cementless stems have been the predominant type of femoral component used for total hip arthroplasty (THA) in the United States for several decades. However, recent literature has reported an increased periprosthetic fracture (PPFx) rate and complications associated with these components, particularly among older patients. This study evaluated the incidence and outcome of Vancouver B PPFx after primary THA using cementless stems.

A single institution's database was used to identify 12,400 primary THAs performed from 2009 through 2023. The mean age at surgery was 64 years, and 57% of THAs were performed among women. All postoperative PPFx were identified, and those classified as Vancouver B were evaluated for treatment method and secondary reoperations.

Among 72 postoperative PPFx, 34 were classified as Vancouver B for an overall rate of 0.3% (34 of 12,400). The median time from THA to Vancouver B PPFx was 33 days. Patients aged > 75 years at surgery had a higher rate of Vancouver B PPFx (0.6%, 13 of 2,094) compared to patients aged 18 to 75 years at surgery (0.2%, 21 of 10,306, P < 0.001). Type C3 triple-taper collared titanium stems had a lower fracture rate (0.1%, four of 4,748) compared to Type A flat taper stems (0.7%, 23 of 3,105, P < 0.001). In patients over 75 at surgery, Type C3 stems had a lower fracture rate (0.3%, three of 923) compared to Type A stems (1.5%, seven of 472, P = 0.04). There were 28 patients who had Vancouver B fractures (82%) who underwent reoperation. Secondary reoperations were performed among 25% (seven of 28) of THAs, and three of these involved periprosthetic joint infection.

Consistent with other reports, the Vancouver B PPFx rate was higher in patients aged > 75 years at surgery. At our institution, Type C3 triple-taper collared titanium stems lowered the PPFx fracture rate in all age groups, including those over age 75 years at surgery. Secondary reoperations remain highly morbid to patients.