Antonio Klasan1,2,3, James Millar4, Jonathan Quayle4, Bill Farrington4, Peter Nicholas Misur4. 1. North Shore Hospital, Auckland, New Zealand. Klasan.antonio@me.com. 2. Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria. Klasan.antonio@me.com. 3. Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria. Klasan.antonio@me.com. 4. North Shore Hospital, Auckland, New Zealand.
Abstract
INTRODUCTION: Periprosthetic femoral fractures (PFF) are detrimental for patients. Vancouver B2 fractures about a cemented stem can be revised to a longer uncemented stem or using an in-cement revision, if the cement mantle is adequate. There are reports documenting the success of both techniques. The aim of this single centre study was to perform a direct comparison of these two procedures. MATERIALS AND METHODS: A retrospective study of consecutive Vancouver B2 PFFs around a cemented stem during 16 years was performed. All study cases were treated either using an in-cement revision or with an uncemented stem revision. Preoperatively, the groups were compared based upon age, gender, ASA, BMI, and Charlson comorbidity score. The outcome measures were surgical time, complications, in-hospital stay, revisions, 1-year readmission rate, and survivorship. RESULTS: After a median of 3.5 years, there were 70 patients in the uncemented and 31 in the in-cement group. There was no difference in any of the preoperative variables. Surgical time was shorter for in-cement revisions by a mean of 45 min (p < 0.001). There was no difference in in-hospital stay, surgical complications or readmissions. Implant survival at 5 years was 93.5% for the in-cement and 94.4% for the uncemented revision (p = 0.946). Patient survivorship at 5 years was 62.5% for the in-cement and 69.8% for the uncemented group (p = 0.094). CONCLUSIONS: This study demonstrates that in-cement revision is a valid treatment option for Vancouver B2 fractures, comparable to uncemented stem revision, if certain criteria are met. There was no difference in revision rate, patient survivorship, complications, readmissions or in-hospital stay.
INTRODUCTION: Periprosthetic femoral fractures (PFF) are detrimental for patients. Vancouver B2 fractures about a cemented stem can be revised to a longer uncemented stem or using an in-cement revision, if the cement mantle is adequate. There are reports documenting the success of both techniques. The aim of this single centre study was to perform a direct comparison of these two procedures. MATERIALS AND METHODS: A retrospective study of consecutive Vancouver B2 PFFs around a cemented stem during 16 years was performed. All study cases were treated either using an in-cement revision or with an uncemented stem revision. Preoperatively, the groups were compared based upon age, gender, ASA, BMI, and Charlson comorbidity score. The outcome measures were surgical time, complications, in-hospital stay, revisions, 1-year readmission rate, and survivorship. RESULTS: After a median of 3.5 years, there were 70 patients in the uncemented and 31 in the in-cement group. There was no difference in any of the preoperative variables. Surgical time was shorter for in-cement revisions by a mean of 45 min (p < 0.001). There was no difference in in-hospital stay, surgical complications or readmissions. Implant survival at 5 years was 93.5% for the in-cement and 94.4% for the uncemented revision (p = 0.946). Patient survivorship at 5 years was 62.5% for the in-cement and 69.8% for the uncemented group (p = 0.094). CONCLUSIONS: This study demonstrates that in-cement revision is a valid treatment option for Vancouver B2 fractures, comparable to uncemented stem revision, if certain criteria are met. There was no difference in revision rate, patient survivorship, complications, readmissions or in-hospital stay.
Authors: John A Ruder; Gavin P Hart; Jeffrey S Kneisl; Bryan D Springer; Madhav A Karunakar Journal: J Arthroplasty Date: 2016-12-23 Impact factor: 4.757
Authors: Peter J Smitham; Tania A Carbone; Scott M Bolam; Young S Kim; Stuart A Callary; Kerry Costi; Donald W Howie; Jacob T Munro; Lucian B Solomon Journal: J Arthroplasty Date: 2019-03-08 Impact factor: 4.757
Authors: Karl Stoffel; Michael Blauth; Alexander Joeris; Andrea Blumenthal; Elke Rometsch Journal: Arch Orthop Trauma Surg Date: 2020-02-21 Impact factor: 3.067