Cement-in-cement Stem Revision for Vancouver Type B Periprosthetic Femoral Fractures After Total Hip Arthroplasty. A 3-year Follow-up of 23 Cases

Overview

Journal Acta Orthop

Specialty Orthopedics

Date 2009 Nov 18

PMID 19916687

Citations 21

Authors

Toby W Briant-Evans

Darmaraja Veeramootoo

Eleftherios Tsiridis

Matthew J Hubble

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Revision surgery for periprosthetic femoral fractures around an unstable cemented femoral stem traditionally requires removal of existing cement. We propose a new technique whereby a well-fixed cement mantle can be retained in cases with simple fractures that can be reduced anatomically when a cemented revision is planned. This technique is well established in femoral stem revision, but not in association with a fracture.

Patients And Methods: We treated 23 Vancouver type B periprosthetic femoral fractures by reducing the fracture and cementing a revision stem into the pre-existing cement mantle, with or without supplementary fixation.

Results: 3 patients died in the first 6 months for reasons unrelated to surgery. In addition, 1 was too frail to attend follow-up and was therefore excluded from the study, and 1 patient underwent revision surgery for a nonunion. The remaining 18 cases all healed with radiographic union after an average time of 4.4 (2-11) months. There was no sign of loosening or subsidence of the revision stems within the old cement mantle in any of these cases at the most recent follow-up after an average of 3 (0.3-9) years.

Interpretation: Our results support the use of the cement-in-cement revision in anatomically reducible periprosthetic fractures with a well-preserved pre-existing cement mantle. This technique is particularly useful for the elderly patient and for those who are not fit for prolonged surgical procedures.

Citing Articles

[Surgical treatment strategies for periprosthetic femoral fractures of type Vancouver B].

Ries C, Gerhardt P, Helwig P, Bathis H, Kirschner S, Rolvien T Orthopadie (Heidelb). 2025; 54(3):205-217.

PMID: 39966160 PMC: 11868169. DOI: 10.1007/s00132-025-04613-y.

Comparative outcomes of uncemented and cemented stem revision in managing periprosthetic femoral fractures: a retrospective cohort study.

Axenhus M, Mukka S, Magneli M, Skoldenberg O J Orthop Traumatol. 2024; 25(1):35.

PMID: 39023807 PMC: 11258106. DOI: 10.1186/s10195-024-00777-z.

Cemented vs cementless stems for revision arthroplasties due to Vancouver B2 periprosthetic hip fracture.

Lara-Taranchenko Y, Nomdedeu Jr J, Aliaga Martinez A, Mimendia I, Barro V, Collado D Eur J Orthop Surg Traumatol. 2024; 34(5):2573-2580.

PMID: 38695885 DOI: 10.1007/s00590-024-03961-3.

Revision total hip arthroplasty for periprosthetic fracture: epidemiology, outcomes, and factors associated with success.

Morgan S, Bourget-Murray J, Garceau S, Grammatopoulos G Ann Jt. 2024; 8:30.

PMID: 38529253 PMC: 10929400. DOI: 10.21037/aoj-23-16.

Open Reduction and Internal Fixation and Cement-In-Cement Revision for Selected Vancouver B Proximal Femur Periprosthetic Fractures.

McCarthy C, Moore J, Tiedt L, Condon F Arthroplast Today. 2022; 19:101071.

PMID: 36561360 PMC: 9764178. DOI: 10.1016/j.artd.2022.101071.

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