Surgery of Vancouver type B2 periprosthetic femoral fracture after total hip arthroplasty in elderly patients: an alternative way with internal fixation

Christophe, Anaïs [UCL] Troussel, Serge [UCL] Detrembleur, Christine [UCL] Putineanu, Dan Constantin [UCL]

Background The periprosthetic femoral fractures after hip arthroplasty represent a challenge for orthopedic surgeons in the oldest patients. The type B2 fracture with stem loosening is usually treated by revision of the implant. We assessed if internal fixation alone could be an alternative for treating the elderly population. This surgical procedure is less complex and can provide enough stability, thus allowing patients to recover their mobility. Methods 26 patients with type B2 fracture were treated. 16 patients had a revision surgery while 10 received internal fixation. The Parker Score, the Functional Ambulation Classification and ambulatory scores were all used before and after surgery. Results The two groups were homogeneous in terms of demographic data, preoperative status and perioperative data. Only the duration of surgery was significantly lower in the internal fixation group. In postoperative, no scores showed differences between groups. In both groups, we observed significant difference in pre-vs early post-operative scores with a decrease of the functional status. At the late postoperatively stage, no significant differences were observed compared to pre-operative scores. The occurrence of complications was similar between the groups. 20% of patients died after internal fixation procedure and 13% after revision. Conclusions There are no differences in terms of autonomy recovery between both procedures. We thus can envision internal fixation as an adequate alternative in elderly patients.