Vancouver type B2 and B3 periprosthetic fractures treated with revision total hip arthroplasty
Amenabar, T., Rahman, W.A., Avhad, V.V. et al.Hip
Purpose
Periprosthetic fractures are the fourth most common cause for hip revision and a devastating complication. Our purpose is to report results and quality of life following revision THA for Vancouver B2 and B3 fractures.
Methods
This was a retrospective review from January 2000 to November 2012 to identify all revision THA performed for Vancouver types B2 and B3 that had a minimum follow-up of two years. Routine post-operative and radiographic evaluation to assess patient survival, implant failure, complications and quality of life was involved. Statistical analysis was made with the Kaplan-Meier survival curve with 95 % confidence interval and the log rank (Mantel-Cox) test.
Results
A total of 76 fractures were included, with an average follow-up 74.4 months. Mean age at the revision surgery was 75.7 years (range, 41–97 years; SD, 12.4). Sixty-six cases were classified as Vancouver B2 and treated with distal fixation stem. Ten cases were Vancouver B3 and a proximal femoral allograft technique was used. The overall five-year Kaplan-Meier survival rate for the patients was 77.9 % (95 % CI, 67.4–88.4), and the ten-year rate was 65.1 % (95 % CI, 51.4–78.8). Five-year Kaplan-Meier survival rate for the implants was 89.6 % (95 % CI, 82.2–97); we presented seven failures. The mean SF-12 mental was 55.1 (range, 31–68; SD, 8.1) and the physical was 37.4 (range, 16–55; SD, 9.4).
Conclusion
Mortality rate after periprosthetic fractures is high as compared to other hip surgeries; our Kaplan-Meier analysis showed that it tends to plateau after five years. In our series the failure rate was low and occurred early in the post-operative period.
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