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Open Reduction Internal Fixation of 105 Vancouver B1 Periprosthetic Femur Fractures: High Mortality at Five Years
Rachel L Honig1, Nicolas A Selemon1, Krystin A Hidden1
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Background:
Periprosthetic femoral fractures around well-fixed femoral components in total hip arthroplasty remain challenging to treat. The purpose of this study was to report implant survivorship, clinical outcomes, and radiographic results of a large series of operatively treated Vancouver B1 periprosthetic femoral fractures.
Methods:
We identified 105 Vancouver B1 fractures treated with open reduction internal fixation between 2001 and 2021. The cumulative incidences of revision and reoperation, accounting for death as a competing risk, were calculated. Mortality, complications, Harris Hip Scores, and radiographic outcomes were assessed. The mean follow-up was three years (range, zero to 16). Among 105 Vancouver B1 fractures, 71% occurred after primary total hip arthroplasty. The majority of the fractures were surrounding cementless implants (75%). The most common fixation construct was cerclage cables and a laterally-based plate (64%).
Results:
The five-year cumulative incidences of revision and reoperation were 14 and 18%, respectively. There were 12 revisions, of which seven were for fracture-related complications, including hardware removal (n = 3), nonunion (n = 3), and one periprosthetic fracture distal to the plate. The remaining revisions were for periprosthetic joint infection (n = 3), recurrent dislocation (n = 1), and aseptic loosening of a femoral component (n = 1). In addition to the 12 revisions, there were five reoperations, all debridement for superficial surgical site infections. Mortality at two years was 24%. The mean Harris Hip Score at a five-year follow-up was 83 (range, 60 to 100). Radiographic union was 96% at the final follow-up.
Conclusions:
Vancouver B1 periprosthetic femoral fractures treated with open reduction internal fixation are associated with good clinical outcomes, with 96% radiographic union and a five-year revision rate of 14%. However, functional outcomes are modest, and in-hospital complication rates are high. Mortality remains high, mirroring rates following native hip fractures.
Level Of Evidence:
III.
