[Surgical treatment strategies for periprosthetic femoral fractures of type Vancouver B].

Abstract

Background: The demographic shift is expected to lead to a further increase in the number of hip joint replacements. Accordingly, as has already been observed in recent years, a further increase in periprosthetic femoral fractures (PPF) is to be expected. PPF is now the third most common reason for revision surgery after hip arthroplasty.

Objectives: Taking into account the known risk factors for PPF, fracture treatment strategies are evaluated based on current evidence in order to make recommendations for practice.

Methods: Narrative review.

Results: Overall, the literature is very heterogeneous and evidence is lacking for many aspects. Numerous recommendations are based on non-randomized studies with low patient count. Mortality after PPF is high regardless of the treatment chosen. Age and bone quality influence the partly heterogeneous results and play a role in the treatment strategy. The use of both cemented and uncemented stems in revision surgery due to proximal PPF is frequently described in the literature. There are no significant differences in terms of outcome. The advantage of uncemented modular stems is currently not supported by the literature.

Conclusions: An individualized approach to the treatment of PPF is recommended, considering environmental factors and comorbidities. In geriatric patients, full weight-bearing of the lower extremity should be aimed for postoperatively to avoid complications.