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Introduction: The purpose of this study was to report mid-term clinical and radiographic results after hip arthroplasty revision in Vancouver type B2 femoral periprosthetic fractures (PPFx). Specifical focus of the paper is as follows: (1) the description of a standardized and reproducible surgical technique, (2) functional outcomes presentation and (3) type and number of complications and implants' survival rate analysis. Methods: We retrospectively reviewed all patients treated for hip revision with non-modular tapered fluted titanium stem in patients with Vancouver type B2 femur PPFx at a single institution. At least 18 months' follow-up period was required. Harris Hip Scores and SF-12 were obtained, and radiographical follow-up was performed. Complications were reported and analyzed. Results: The authors included 114 patients (114 hips) with a mean follow-up of 62.8 ± 30.6 months. All patients were treated with Wagner SL revision hip stem (Zimmer-Biomet), metal cerclage wires ± trochanteric plate. The mean HHS and SF-12 score at the last follow-up evaluation were respectively 81.3 ± 9.7 and 32.5 ± 7.6. Seventeen (14.9%) complications occurred. We observed five cases of dislocations, two of periprosthetic joint infections and six cases of new PPFx. The stem-related revision rate for any cause at the final FU was 1.7%, due to PJI. No patients underwent stem revision surgery for aseptic loosening. Fracture healed in all the included patients with a union-rate of 100%. The re-operation rate for any cause was 9.6%, with an implant survival rate for overall failure of 96.5%. Conclusion: The presented standard and reproducible surgical technique obtains optimal clinical and radiological results with limited complication rate at mid-term follow up. Preoperative planning as well as careful intraoperative surgical technique is of a paramount importance. [ABSTRACT FROM AUTHOR]

Introduction: Periprosthetic femur fractures are complex injuries that can be difficult to treat and recover from. With a growing number of total hip arthroplasties (THA) and revision arthroplasties being performed in an aging population, the incidence of these injuries is on the rise. Multiple studies exist detailing outcomes associated with periprosthetic femur fractures after THA, but no study has directly compared the post-operative course between fracture types as classified by the Vancouver classification system. This study compares the three Vancouver B fracture types to see if any type is associated with an increase in post-operative complications than others. Materials and methods: This retrospective chart review was conducted at a suburban orthopedic surgery department. Overall, 122 patients who presented to our hospital with periprosthetic proximal femur fractures after hip arthroplasty over the past 13 years were reviewed. Patients were included if they underwent surgical stabilization of their femur fracture. Patients were excluded if they underwent non-operative treatment or had missing chart information. For each patient, demographic information, fracture information, surgical information, post-operative course, and post-operative opioid usage were recorded and compared among groups. Results: Overall, 88 fractures were included. Fifty-five (62.5%) were Vancouver type B1, 27 (30.7%) were Vancouver type B2, and 6 (6.8%) were Vancouver type B3. Most of our patients were female (n = 62, 70.5%) and older than 81 years of age (n = 53, 60.2%) with uncemented prosthesis (n = 83, 94.3%). All three fracture groups had statistically similar union rates (p = 0.77), infection rates (p = 0.32), subsequent fractures (p = 0.63), repeat surgeries (p = 0.64), and post-operative opioid use (measured in milli-morphine equivalents) after surgical stabilization (p = 0.96). Conclusions: While periprosthetic femur fractures after hip arthroplasty are associated with high complication rates and poor outcomes, there is no difference in union rate, infection rate, subsequent fractures, repeat surgery rate, and opioid usage between the different Vancouver B fracture types. Level of evidence: Prognostic level III. [ABSTRACT FROM AUTHOR]