Search

Introduction: A new type of periprosthetic fracture, between Vancouver-SoFCOT types A and B, was recently described and labeled "new B2". It occurs intraoperatively or in the early postoperative period, on cementless implants, and features a posteromedial cortical fragment around the lesser trochanter. The main aim of the present study was to report clinical and radiological results in a series of 33 cases of what is better called Vancouver B-lesser trochanter (VB-LT) fracture. The secondary objective was to identify risk factors. The study hypothesis was that VB-LT fracture might occur in the late postoperative course., Material and Method: A2 single-center retrospective study included all patients with postoperative periprosthetic VB-LT fracture diagnosed on standard X-ray. Treatment was operative or non-operative depending on femoral implant subsidence and the patient's general health status., Results: There were 33 VB-LT fractures out of 445 periprosthetic femoral fractures (7.5%), in 27 women and 6 men; all were postoperative, at a mean 47 months (range, 1 day to 20 years). Mean subsidence of the femoral stem was 8.8mm, in 73% of cases (24 out of 33 implants). The 9 VB-LT1 fractures (without subsidence) were treated non-operatively, without secondary displacement. Thirteen of the 24 VB-LT2 fractures (with subsidence) were managed by stem exchange and cerclage; 3 other patients had isolated stem exchange, 2 had isolated internal fixation by cerclage, and 6 in poor health were managed non-operatively. At a mean 28 months' follow-up (range, 6-48 months), mean PMA score was 15.5 (range, 10-18), Harris Hip score 72.4 (range, 43-100) and Parker score 7.2 (range, 4-9). All cases showed osseointegration and implant stability; there was 1 case of non-union, without impact on stability., Conclusion: Postoperative Vancouver B-lesser trochanter fracture seemed specific to cementless implants and did not occur exclusively in the early postoperative period. Non-operative treatment gave good results when there was no implant subsidence (type VB-LT1)., Level of Evidence: IV, retrospective., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Introduction: The use of a primary cementless component is a tempting option for revision total hip arthrosplasty (reTHA), however, the results of this type of revision have not been clearly determined. The goal of this retrospective study was to determine: if revision with a primary anatomical cementless femoral stem gives adequate bone fixation; the rate of secondary subsidence or recurrent loosening; the survival rate with this device., Hypothesis: Revision with a primary anatomical cementless femoral stem results in a low rate of subsidence and recurrent loosening., Materials and Methods: This retrospective series of 43 reTHA performed between 1994 and 2012 included 43 patients, mean age 66 years old (37-90) with a minimum follow-up of 24months. There were grade 1 (n=24) or 2A (n=19) bone defects according to the Paprosky classification. The causes of revision were: aseptic loosening in 27, septic loosening in 6, malposition of the implant in 7 and periprosthetic fractures in 3. Clinical (Postel Merle d'Aubigné [PMA] and Harris scores), and radiological (subsidence) assessment was performed, as well as survival analysis (with a 95% confidence interval)., Results: All components were changed through posterolateral approach without femorotomy. In four cases de-escalation (use of a primary component for secondary revision of a prior revision component) was performed. There were no perioperative fractures or perforations. After a mean 47months (24-134), the mean PMA score increased from 10 (5-15) to 16 (11-18), and the Harris score from 58 (20-80) to 85 (66-96). Radiological assessment did not show any extensive radiolucencies or secondary subsidence. Only 3 components were placed in a varus position, with no clinical consequences. One patient had subsequent revision for recurrent dislocations. Estimated survival at 80months by Kaplan-Meier analysis was 85% (CI 95%: 64-100%)., Discussion: There are very few studies in the literature (7 series) on this topic, which shows the reluctance of surgeons to use this technique. Placement of a primary femoral stem requires good metaphyseal bone quality for primary stability. Thus, the indication is limited to Paprosky 1 and 2A stages. Revision surgery must be performed by endofemoral approach requiring good preoperative planning, as well as knowledge of the explanted component and a revision component must be available, if necessary, in the operating room., Level of Evidence: Retrospective study, level 4., (Copyright © 2016. Published by Elsevier Masson SAS.)