Mortality and clinical outcomes of Vancouver type B periprosthetic femoral fractures : a multicentre retrospective study

Hideomi Takami; Yasuhiko Takegami; Katsuhiro Tokutake; Hiroshi Kurokawa; Manato Iwata; Satoshi Terasawa; Takeshi Oguchi; Shiro Imagama

doi:10.1302/2633-1462.41.BJO-2022-0145.R1

Mortality and clinical outcomes of Vancouver type B periprosthetic femoral fractures : a multicentre retrospective study

Bone Jt Open. 2023 Jan;4(1):38-46. doi: 10.1302/2633-1462.41.BJO-2022-0145.R1.

Authors

Hideomi Takami¹, Yasuhiko Takegami¹, Katsuhiro Tokutake², Hiroshi Kurokawa¹, Manato Iwata¹, Satoshi Terasawa¹, Takeshi Oguchi³, Shiro Imagama¹

Affiliations

¹ Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
² Department of Hand Surgery, Nagoya University, Nagoya, Japan.
³ Department of Orhopedic Surgery, Anjo Kosei Hospital, Anjo, Japan.

PMID: 36647618
PMCID: PMC9887342
DOI: 10.1302/2633-1462.41.BJO-2022-0145.R1

Abstract

Aims: The objectives of this study were to investigate the patient characteristics and mortality of Vancouver type B periprosthetic femoral fractures (PFF) subgroups divided into two groups according to femoral component stability and to compare postoperative clinical outcomes according to treatment in Vancouver type B2 and B3 fractures.

Methods: A total of 126 Vancouver type B fractures were analyzed from 2010 to 2019 in 11 associated centres' database (named TRON). We divided the patients into two Vancouver type B subtypes according to implant stability. Patient demographics and functional scores were assessed in the Vancouver type B subtypes. We estimated the mortality according to various patient characteristics and clinical outcomes between the open reduction internal fixation (ORIF) and revision arthroplasty (revision) groups in patients with unstable subtype.

Results: The one-year mortality rate of the stable and unstable subtype of Vancouver type B was 9.4% and 16.4%. Patient demographic factors, including residential status and pre-injury mobility were associated with mortality. There was no significant difference in mortality between patients treated with ORIF and Revision in either Vancouver B subtype. Patients treated with revision had significantly higher Parker Mobility Score (PMS) values (5.48 vs 3.43; p = 0.00461) and a significantly lower visual analogue scale (VAS) values (1.06 vs 1.94; p = 0.0399) for pain than ORIF in the unstable subtype.

Conclusion: Among patients with Vancouver type B fractures, frail patients, such as those with worse scores for residential status and pre-injury mobility, had a high mortality rate. There was no significant difference in mortality between patients treated with ORIF and those treated with revision. However, in the unstable subtype, the PMS and VAS values at the final follow-up examination were significantly better in patients who received revision. Based on postoperative activities of daily life, we therefore recommend evision in instances when either treatment option is feasible.Cite this article: Bone Jt Open 2023;4(1):38-46.

Keywords: Charlson Comorbidity Index (CCI); Vancouver type B; clinical outcomes; femoral component; functional scores; internal fixation; open reduction internal fixation; open reduction internal fixation (ORIF); orthopaedic surgeons; periprosthetic femoral fractures; revision arthroplasties; revision arthroplasty; visual analogue scale (VAS).