Outcomes of Vancouver C Periprosthetic Femur Fractures

Elizabeth B. Gausden, Meagan E. Tibbo, Kevin I. Perry, Daniel J. Berry, Brandon J. Yuan, Matthew P. Abdel

Research output: Contribution to journalArticlepeer-review


Background: Periprosthetic femur fractures (PFFs) that occur distal to a total hip arthroplasty, Vancouver C fractures, are challenging to treat. We aimed to report patient mortality, reoperations, and complications following Vancouver C PFFs in a contemporary cohort all treated with a laterally based locking plate. Methods: We retrospectively identified 42 consecutive Vancouver C PFFs between 2004 and 2018. There was a high prevalence of comorbidities, including 9 patients with neurologic conditions, 9 with a history of cancer, 8 diabetics, and 8 using chronic anticoagulation. Mean time from total hip arthroplasty to PFF was 6 years (range 1 month to 25 years). All fractures were treated with a laterally based locking plate. Fixation bypassed the femoral component in 98% of cases and extended as proximal as the lesser trochanter in 18%. Kaplan-Meier survival was used for patient mortality, and a competing risk model was used to analyze survivorship free of reoperation and nonunion. Mean follow-up was 2 years. Results: Patient mortality was 5% at 90 days and 31% at 2 years. Cumulative incidence of reoperation was 13% at 2 years. There were 5 reoperations including revision osteosynthesis for nonunion and/or hardware failure (2), debridement and hardware removal for infection (2), and removal of hardware and total knee arthroplasty for post-traumatic arthritis (1). Cumulative incidence of nonunion was 10% at 2 years. Conclusion: Patients who sustained a Vancouver C PFFs had a high mortality rate (31%) at 2 years. Moreover, 13% of patients required a reoperation within 2 years, most commonly for infection or nonunion.

Original languageEnglish (US)
Pages (from-to)3601-3607
Number of pages7
JournalJournal of Arthroplasty
Issue number10
StatePublished - Oct 2021


  • complications following total hip arthroplasty
  • fragility fractures
  • nonunion of femur fractures
  • osteoporotic fractures
  • trauma after hip replacement

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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