Operatively Managed Transverse or Short Oblique B1 Periprosthetic Fractures Around a Polished Taper-Slip Femoral Stem Are Associated With Reoperation in One Third of Cases: A Retrospective Cohort Study

Matilda F R Powell-Bowns; Damien Martin; Abbey Bowley; Matthew Moran; Nick D Clement; Chloe E H Scott

doi:10.1016/j.artd.2024.101551

Operatively Managed Transverse or Short Oblique B1 Periprosthetic Fractures Around a Polished Taper-Slip Femoral Stem Are Associated With Reoperation in One Third of Cases: A Retrospective Cohort Study

Arthroplast Today. 2024 Nov 13:30:101551. doi: 10.1016/j.artd.2024.101551. eCollection 2024 Dec.

Authors

Matilda F R Powell-Bowns¹, Damien Martin¹, Abbey Bowley², Matthew Moran¹, Nick D Clement^{1

2}, Chloe E H Scott^{1

2}

Affiliations

¹ Royal Infirmary of Edinburgh, Edinburgh, Scotland.
² University of Edinburgh, Edinburgh, Scotland.

Abstract

Background: Transverse or short oblique periprosthetic femoral fractures around total hip arthroplasty (THA) stems are typically classified as B1 fractures (stem well-fixed) and usually managed with fixation. These fractures have high non-union rates. This study aimed to identify reoperation rates in patients with operatively managed transverse or short oblique fractures around a cemented polished taper-slip stem and determine any associations with treatment failure.

Methods: This retrospective cohort study included 31 patients with Arbeitsgemeinschaft für Osteosynthesefragen transverse or short oblique Vancouver B1 periprosthetic femoral fractures around THA with a cemented taper slip stem: 12 males (39%); mean age 74 ± 11.9 years (range 44-91); mean BMI 28.5 ± 1.4 (range 16-48); median American Society of Anesthesiologists score 3. Patient journeys were assessed and re-interventions recorded. The primary outcome was reoperation.

Results: The mean time from primary THA to fracture was 11.3 ± 7.8 years (0.5-26 years). Surgical management involved fixation in 27/31 cases and revision-THA (r-THA) in 4/31. Ten patients (32%) required reoperation (8 following ORIF and 2 following r-THA, P = .584), most commonly within 2 years of injury (9/10) due to non-union (6/10). No significant associations with reoperation requirement were identified. Kaplan-Meier survival free from reoperation was 67.4% (95% CI 49.8-85.0) at 2 years, unaffected by initial management with fixation or revision (Log rank 0.898). Of those reoperated, 60% (6/10) required multiple reoperations to achieve bony union or a stable revision construct.

Conclusions: These fractures are challenging to manage with either fixation or revision. Patients should be counseled about a one in 3 risk of reoperation and a one in 5 risk of requiring multiple reoperations.

Keywords: Failure; Non-union; Periprosthetic femoral fractures; Short oblique; Transverse.