Management of Vancouver B2 Periprosthetic Femoral Fractures, Revision Total Hip Arthroplasty Versus Open Reduction and Internal Fixation: A Systematic Review and Meta-Analysis.

Abstract

To identify and analyze the current evidence for the use of open reduction and internal fixation (ORIF) constructs compared with conventional revision total hip arthroplasty (rTHA) for the management of Vancouver B2 periprosthetic femoral fractures (PFFs). A systematic literature search of the MEDLINE, CINAHL, and EMBASE databases was conducted. Prospective and retrospective studies were eligible. No limitation was placed on publication date, with only articles printed in English eligible. Included studies were retrospective studies comparing ORIF and rTHA for the management of Vancouver B2 PFFs. The primary outcome was the overall complication rate. Other outcomes included as rate of dislocation, revision operation, refracture, infection, nonunion, and subsidence/loosening. Twenty-four studies were included totaling 1621 patients, of which 331 were treated with ORIF and 1280 with rTHA. The 1621 patients included comprised a mixture of different fracture patterns, prostheses, and patient comorbidities. The overall complication rate for ORIF was 24% versus 18% for rTHA (P = 0.13). The results demonstrate that rTHA has a similar revision rate to ORIF in PFFs with a loose femoral component and adequate bone stock. ORIF was superior to rTHA in prevention of postoperative dislocation; however, there was no difference between other complications. This review suggests a potential role of both ORIF and rTHA in the management of Vancouver B2 PFFs. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.