Background: 

Modular fluted tapered (MFT) stems have advanced treatment of Vancouver B₂ and B₃ periprosthetic femoral fractures, but series to date have been limited with respect to cohort size and follow-up duration. The purpose of this study was to determine implant survivorship, radiographic results, complications, and clinical outcomes of Vancouver B₂ and B₃ periprosthetic femoral fractures treated with MFT stems in a large series of patients.

Methods: 

We identified 171 Vancouver B₂ (109) and B₃ (62) periprosthetic femoral fractures treated with an MFT stem between 2000 and 2018 using our institutional total joint registry. The mean age was 75 years, 50% were female, and the mean body mass index was 29 kg/m². The median stem diameter was 18 mm and median stem length was 210 mm. The cumulative incidences of revision and reoperation with death as the competing risk were calculated, radiographs were reviewed, and clinical outcomes were evaluated using the Harris hip score (HHS). The mean follow-up was 5 years.

Results: 

The 10-year cumulative incidence of any revision was 10%. There were 17 revisions, of which only 3 were for the distal fluted portion of the MFT stem. Revision indications included periprosthetic joint infection (PJI) (n = 6) and dislocation (n = 11). The 10-year cumulative incidence of any reoperation was 15%. In addition to the above 17 revisions, there were 7 reoperations for superficial wound complications (n = 4), Vancouver B₁ periprosthetic femoral fracture (n = 1), vascular occlusion (n = 1), and acetabular cartilage degeneration requiring an acetabular component (n = 1). Radiographically, there was 1 fracture nonunion. All unrevised MFT stems were radiographically well fixed. Subsidence of ≥5 mm occurred in 11%, but all implants were stable at the most recent follow-up. The mean HHS was 75 at 2 years (n = 71).

Conclusions: 

In this large series of 171 Vancouver B₂ and B₃ periprosthetic femoral fractures treated with MFT stems, we found that such constructs were associated with a high rate of fracture healing and provided extremely reliable and durable implant fixation, with no revisions for aseptic loosening. Dislocation and PJI were the most common complications.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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用于股骨假体周围骨折的模块化凹槽锥形柄：171 例疗效极佳

背景： 

模块化凹槽锥形 (MFT) 柄对温哥华 B ₂和 B ₃股骨假体周围骨折进行了先进的治疗，但迄今为止的系列在队列规模和随访时间方面受到限制。本研究的目的是确定温哥华 B ₂和 B ₃股骨假体周围骨折在大量患者中使用 MFT 股骨柄治疗的植入物存活率、影像学结果、并发症和临床结果。

方法： 

我们使用我们的机构总联合登记处确定了 2000 年至 2018 年间用 MFT 柄治疗的 171 例温哥华 B ₂ (109) 和 B ₃ (62) 股骨假体周围骨折。平均年龄为 75 岁，50% 为女性，平均体重指数为 29 kg/m ²。中位茎直径为 18 毫米，中位茎长度为 210 毫米。计算了作为竞争风险的翻修和再手术的累积发生率，审查了放射线照片，并使用哈里斯髋关节评分 (HHS) 评估了临床结果。平均随访时间为 5 年。

结果： 

任何翻修的 10 年累积发生率为 10%。共进行了 17 次修订，其中只有 3 次针对 MFT 柄的远端凹槽部分。翻修适应症包括假体周围感染 (PJI) (n = 6) 和脱位 (n = 11)。任何再手术的 10 年累积发生率为 15%。除上述 17 次翻修外，还有 7 次因浅表伤口并发症再次手术（n = 4），温哥华 B ₁假体周围股骨骨折 (n = 1)、血管闭塞 (n = 1) 和需要髋臼组件的髋臼软骨退变 (n = 1)。影像学上，有 1 例骨折不愈合。所有未修订的 MFT 茎在放射学上都很好地固定。11% 发生 ≥5 mm 的下沉，但在最近一次随访中所有种植体均稳定。2 年时的平均 HHS 为 75（n = 71）。

结论： 

在这个大系列的 171 例温哥华 B ₂和 B ₃股骨假体周围骨折用 MFT 股骨柄治疗中，我们发现这种结构与骨折愈合率高相关，并提供了极其可靠和持久的植入物固定，无需对无菌松动进行翻修。脱位和 PJI 是最常见的并发症。

证据等级： 

治疗级别 IV。有关证据级别的完整描述，请参见作者说明。