JOA - 2026-05-07 - Journal Article
Open Reduction Internal Fixation of 105 Vancouver B 1 Periprosthetic Femur Fractures: High Mortality at 5 Years.
Honig RL, Selemon NA, Hidden KA, Abdel MP, Yuan BJ, Hannon CP
Topics
Key Takeaway
ORIF of Vancouver B1 periprosthetic femoral fractures achieves 96% radiographic union but carries 24% two-year mortality and a 14% five-year revision rate.
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Summary
This study evaluated implant survivorship, clinical outcomes, and radiographic results in 105 Vancouver B1 periprosthetic femoral fractures treated with ORIF between 2001 and 2021, with 71% occurring after primary THA and 75% involving cementless stems. Five-year cumulative incidences of revision and reoperation were 14% and 18%, respectively, with nonunion and hardware failure accounting for the majority of fracture-related revisions. Radiographic union was 96%, mean HHS at five years was 83, but two-year mortality reached 24%, comparable to native hip fracture mortality.
Key Limitation
Heterogeneous fixation constructs across a 20-year period preclude determination of which specific implant or technique drives the 14% revision rate.
Original Abstract
INTRODUCTION
Periprosthetic femoral fractures around well-fixed femoral components in total hip arthroplasty (THA) remain challenging to treat. The purpose of this study was to report implant survivorship, clinical outcomes, and radiographic results of a large series of operatively treated Vancouver B 1 periprosthetic femoral fractures.
METHODS
We identified 105 Vancouver B 1 fractures treated with open reduction internal fixation (ORIF) between 2001 and 2021. The cumulative incidences of revision and reoperation, accounting for death as a competing risk, were calculated. Mortality, complications, Harris hip scores (HHS), and radiographic outcomes were assessed. The mean follow-up was three years (range, zero to 16). Among 105 Vancouver B 1 fractures, 71% occurred after primary THA. The majority of the fractures were surrounding cementless implants (75%). The most common fixation construct was cerclage cables and a laterally-based plate (64%).
RESULTS
The five-year cumulative incidences of revision and reoperation were 14 and 18%, respectively. There were 12 revisions, of which seven were for fracture-related complications, including hardware removal (n = 3), nonunion (n = 3), and one periprosthetic fracture distal to the plate. The remaining revisions were for periprosthetic joint infection (n = 3), recurrent dislocation (n = 1), and aseptic loosening of a femoral component (n = 1). In addition to the 12 revisions, there were five reoperations, all debridements for superficial surgical site infections. Mortality at two years was 24%. The mean HHS at a five-year follow-up was 83 (range, 60 to 100). Radiographic union was 96% at the final follow-up.
DISCUSSION
Vancouver B 1 periprosthetic femoral fractures treated with ORIF are associated with good clinical outcomes, with 96% radiographic union and a five-year revision rate of 14%. However, functional outcomes are modest, and in-hospital complication rates are high. Mortality remains high, mirroring rates following native hip fractures.