Periprosthetic femur fractures treated with modular fluted, tapered stems

Background: Treatment of periprosthetic femur fractures is challenging, and high failure and complication rates have been reported in many series. The optimal techniques and implants for the management of Vancouver B2 and B3 fractures remain in debate. Questions/purposes: The purpose of this study was to evaluate the results of a relatively new class of femoral implants, uncemented fluted, tapered, modular stems, to treat periprosthetic femur fractures; we specifically evaluated (1) fracture union; (2) implant stability; (3) patient outcomes; and (4) complications. Methods: We retrospectively identified 44 Vancouver B2 (25 patients) and B3 (19 patients) periprosthetic femur fractures treated consecutively with fluted, tapered stems at a single institution from 2000 to 2006. The mean patient age was 72 years (range, 34-92 years), and 24 were women. The minimum followup was 2 years (mean, 4.5 years; range, 2-8 years). Results: Forty-three of 44 (98%) fractures healed radiographically and 43 of 44 (98%) femoral components were stable radiographically at latest followup. The mean postoperative Harris hip score was 83. There were seven additional reoperations (five for recurrent instability, two for deep infections). Conclusions: Modular fluted, tapered stems provide a reliable treatment method for Vancouver B2 and B3 periprosthetic femoral fractures with a high rate of fracture union and implant osteointegration. The most common complication, instability, may be reduced by more consistent use of larger femoral head diameters. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.