091 CEMENT-IN-CEMENT STEM REVISION FOR VANCOUVER TYPE B PERIPROSTHETIC FEMORAL FRACTURES AFTER TOTAL HIP ARTHROPLASTY: 3 YEAR FOLLOW UP OF 24 CASES

Abstract

Periprosthetic fractures around a cemented femoral stem present a challenge to the treating surgeon. We propose a technique whereby a well fixed cement mantle can be retained in cases with simple fractures that can be reduced anatomically. This technique is well established in femoral stem revision, but not in association with a fracture.

24 Vancouver type B periprosthetic femoral fractures were treated by reducing the fracture and cementing a revision stem into the pre-existing cement mantle, with or without supplementary fixation.

3 patients died in the first 6 months for reasons not related to surgery and one was too frail to attend follow up. The remaining 20 cases were followed up for a mean of 3.0 years. The median time to radiological and clinical union was 3.0 months (2–11). The median Modified Harris Hip Score was 76.9 (35–97) and there was no sign of loosening or subsidence of the revision stems within the old cement mantle in any case at most recent follow up. One patient had further surgery for a delayed union and there were 2 subsequent fractures distal to the original fracture site in patients with poor bone stock.

Our results support the use of the cement-in-cement stem revision technique in anatomically reducible peri-prosthetic fractures with a well preserved pre-existing cement mantle. It is particularly suitable for older patients.