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Background <p>Vancouver B2 and B3 periprosthetic femur fractures (PPFF) have posed significant treatment challenges due to stem instability and lack of adequate femoral bone stock. This study investigated subsidence, survivorship, and outcomes of Vancouver B2 and B3 fractures, based on the order in which revision stem placement and fracture reduction occurred during revision total hip arthroplasty (rTHA).</p> Methods <p>This retrospective, cohort study included 46 rTHAs between June 2011 and April 2023. Included patients underwent rTHA for Vancouver B2 or B3 PPFF with minimum one-year radiographic and two-year clinical follow-up. All patients were treated with diaphyseal-engaging tapered fluted titanium stems and stem modularity decisions were based on surgeon preference. Cohorts were separated based on if stem placement (SF, <i>n</i> = 19), or fracture reduction (RF, <i>n</i> = 27) occurred first. Patient demographics, intraoperative information, and clinical and radiographic outcomes were collected.</p> Results <p>The SF and RF cohort showed no statistically significant differences in rate of subsidence ≥5&#xa0;mm [26.3%[SF], 22.2%[RF], <i>P</i> = 0.749), rate of subsidence ≥ 10&#xa0;mm (15.8%[SF], 14.8%[RF], <i>P =</i> 0.928), nor average subsidence (4.1&#xa0;mm[SF], 4.4&#xa0;mm[RF], <i>P</i> = 0.861). We found no statistically significant differences in surgery-related clinical outcomes or all-cause revision rates within a two-year follow-up period. The groups demonstrated comparable rates of procedure-related 90-day emergency department visits(<i>P</i> = 0.370) and readmissions(<i>P</i> = 0.712). The SF group underwent four revisions for three PJIs and one acetabular component aseptic loosening. The RF cohort underwent four revisions for one acetabular component aseptic loosening, one dislocation, one PPFF, and one PJI. Rates of all-cause revision were comparable(<i>P =</i> 0.583). There was one case within the RF cohort to explant the trochanteric plate with no revision of arthroplasty components.</p> Conclusions <p>The present analysis suggests the order in which intraoperative femoral stem implantation and fracture reduction occurs does not affect short-term clinical and radiographic outcomes. This intraoperative decision should be based upon patient anatomy, fracture patterns, and surgeon discretion.</p>

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Does the order matter? Comparing the order of stem placement and fracture reduction in revision total hip arthroplasty for Vancouver B2 and B3 periprosthetic femur fractures

  • 期刊论文

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  • 发表日期：

    2026年6月3日

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  • Sophia S. Antonioli,
  • Farouk Khury,
  • Mitchell F. Kennedy,
  • Muhammad A. Haider,
  • Alexander Duke,
  • Ran Schwarzkopf,
  • Vinay K. Aggarwal

摘要

Background

Vancouver B2 and B3 periprosthetic femur fractures (PPFF) have posed significant treatment challenges due to stem instability and lack of adequate femoral bone stock. This study investigated subsidence, survivorship, and outcomes of Vancouver B2 and B3 fractures, based on the order in which revision stem placement and fracture reduction occurred during revision total hip arthroplasty (rTHA).

Methods

This retrospective, cohort study included 46 rTHAs between June 2011 and April 2023. Included patients underwent rTHA for Vancouver B2 or B3 PPFF with minimum one-year radiographic and two-year clinical follow-up. All patients were treated with diaphyseal-engaging tapered fluted titanium stems and stem modularity decisions were based on surgeon preference. Cohorts were separated based on if stem placement (SF, n = 19), or fracture reduction (RF, n = 27) occurred first. Patient demographics, intraoperative information, and clinical and radiographic outcomes were collected.

Results

The SF and RF cohort showed no statistically significant differences in rate of subsidence ≥5 mm [26.3%[SF], 22.2%[RF], P = 0.749), rate of subsidence ≥ 10 mm (15.8%[SF], 14.8%[RF], P = 0.928), nor average subsidence (4.1 mm[SF], 4.4 mm[RF], P = 0.861). We found no statistically significant differences in surgery-related clinical outcomes or all-cause revision rates within a two-year follow-up period. The groups demonstrated comparable rates of procedure-related 90-day emergency department visits(P = 0.370) and readmissions(P = 0.712). The SF group underwent four revisions for three PJIs and one acetabular component aseptic loosening. The RF cohort underwent four revisions for one acetabular component aseptic loosening, one dislocation, one PPFF, and one PJI. Rates of all-cause revision were comparable(P = 0.583). There was one case within the RF cohort to explant the trochanteric plate with no revision of arthroplasty components.

Conclusions

The present analysis suggests the order in which intraoperative femoral stem implantation and fracture reduction occurs does not affect short-term clinical and radiographic outcomes. This intraoperative decision should be based upon patient anatomy, fracture patterns, and surgeon discretion.