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Lara-Taranchenko Y, Nomdedéu JF, Aliaga Martínez A, Mimendia I, Barro VM, Collado D, Guerra-Farfán E, Hernández A. Cemented vs cementless stems for revision arthroplasties due to Vancouver B2 periprosthetic hip fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2573-2580. [PMID: 38695885 DOI: 10.1007/s00590-024-03961-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/14/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE According to Vancouver classification, B2 type fractures are most often treated with removal of the loose stem and implantation of a long stem that bypasses the fracture site. However, there is a controversy about the stem fixation that should be used: cemented or cementless. Hence, this study aims to compare cemented and cementless stems in prosthetic revision due to Vancouver B2 (VB2) periprosthetic hip fracture. METHODS A retrospective study was done including all the patients treated with stem exchange due to VB2 periprosthetic hip fracture in a tertiary hospital between 2015 and 2022. Patients were divided into two groups according to the stem fixation used: cemented or cementless. Functional outcomes, hospital stay, surgical time, complication rate, and mortality were compared between the two groups of patients. RESULTS Of the 30 included patients, 13 (43.4%) were treated with cementless stems and 17 (56.7%) with cemented stems. There were no statistically significant differences in age, gender, anesthesia risk scale (ASA) or functional capacity prior to the intervention. Patients treated with cementless stems had a higher complication and reintervention rate than those treated with cemented stems: 62 and 45% versus 34 and 6% (p = 0.035; p = 0.010), respectively. Furthermore, in the group of cementless stems a higher proportion of non-union was found (53.8% vs. 17.6%; p = 0.037). Also, the hospital stay (33 vs. 24 days; p = 0.037) and the time to full weight-bearing (21 days vs. 9 days; p < 0.001) were longer in the cementless stem group. CONCLUSION Cemented fixation in stem revision due to Vancouver B2 periprosthetic hip fracture could be an optimal option with faster recovery which could decrease the rate of complications and reintervention, without compromising the fracture healing and patient mortality. Thus, this option can be considered when an anatomical reduction can be obtained, especially in elderly patients with multiple comorbidities in which a less aggressive surgical option should be considered.
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Affiliation(s)
- Yuri Lara-Taranchenko
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Josep F Nomdedéu
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Andrés Aliaga Martínez
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Iñaki Mimendia
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Víctor M Barro
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Diego Collado
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Ernesto Guerra-Farfán
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Alejandro Hernández
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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Mondanelli N, Troiano E, Facchini A, Cesari M, Colasanti GB, Bottai V, Muratori F, Caffarelli C, Gonnelli S, Giannotti S. Combined Surgical and Medical Treatment for Vancouver B1 and C Periprosthetic Femoral Fractures: A Proposal of a Therapeutic Algorithm While Retaining the Original Stable Stem. Geriatr Orthop Surg Rehabil 2021; 12:21514593211067072. [PMID: 34992896 PMCID: PMC8725223 DOI: 10.1177/21514593211067072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/30/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION There is lack of consensus regarding best operative fixation strategy for periprosthetic femoral fractures (PFFs) around a stable stem. Evidence exists that some patterns of fracture around a stable stem are better treated with revision surgery than with standard fixation. Anyway, a more aggressive surgical procedure together with medical treatment could allow for stem retention, and reduced risk of nonunion/hardware failure, even in these cases. SIGNIFICANCE This paper is placed in a broader context of lack of studies on the matter, and its aim is to shed some light on the management of PFFs around a stable stem, when peculiar mechanical and biological aspects are present. RESULTS Based on our casuistry in the treatment of nonunions after PFF successfully treated with original stem retention, and on review of Literature about risk factors for fixation failure, an algorithm is proposed that can guide in choosing the ideal surgical technique even for first-time PFFs with a stable stem, without resorting to revision. Mechanical (major and minor) and biological (local and systemic) factors that may influence fracture healing, leading to nonunion and hardware failure, and subsequent need for re-operation, are considered. The proposed surgical technique consists of rigid fixation with absolute stability (using a plate and structural allograft) plus local biological support (structural allograft and autologous bone marrow concentrate over a platelet-rich plasma-based scaffold) at fracture site. Systemic anabolic treatment (Teriparatide) is also administered in the post-operative period. CONCLUSION Mechanical factors are not the only issues to be considered when choosing the surgical approach to PFFs over a stable stem. Systemic and local biological conditions should be taken into account, as well. A therapeutic algorithm is proposed, given the prosthetic stem to be stable, considering mechanical and biological criteria.
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Affiliation(s)
- Nicola Mondanelli
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Elisa Troiano
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Andrea Facchini
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Martina Cesari
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | | | - Vanna Bottai
- Second Clinic of Orthopedic and
Traumatology, University of Pisa, Pisa, Italy
| | - Francesco Muratori
- Section of Orthopedic Oncology and
Reconstructive Surgery, Azienda Ospedaliero-Universitaria
Careggi, Firenze, Italy
| | - Carla Caffarelli
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Internal Medicine, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Stefano Gonnelli
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Internal Medicine, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Stefano Giannotti
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
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