Fracture Morphology and Extraction-Related Femoral Damages in Short Versus Standard Cementless Stems: Analyses of Vancouver B2 Fractures and Well-Fixed Nonfracture Revisions

IF 2.1 Q3 ORTHOPEDICS

Arthroplasty Today Pub Date : 2026-10-01 Epub Date: 2026-10-09 DOI:10.1016/j.artd.2026.102150

Dominic Simon MD, Gautier Beckers MD, Florian Pachmann MD, Amir Koutp MD, Salome Hagelstein MD, Eduardo Suero MD, Boris M. Holzapfel MD, PhD, Lukas Leitner MD, PhD

{"title":"Fracture Morphology and Extraction-Related Femoral Damages in Short Versus Standard Cementless Stems: Analyses of Vancouver B2 Fractures and Well-Fixed Nonfracture Revisions","authors":"Dominic Simon MD, Gautier Beckers MD, Florian Pachmann MD, Amir Koutp MD, Salome Hagelstein MD, Eduardo Suero MD, Boris M. Holzapfel MD, PhD, Lukas Leitner MD, PhD","doi":"10.1016/j.artd.2026.102150","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Short-stem total hip arthroplasty is increasingly used because of its bone-preserving, minimally invasive concept. Revision may occur in two fundamentally different situations: Vancouver B2 periprosthetic femoral fracture (PFF) with an unstable stem or removal of a well-fixed osseointegrated stem for a nonfracture indication. This study evaluated whether stem design is associated with distinct fracture morphology and extraction-related femoral damage.</div></div><div><h3>Methods</h3><div>This retrospective two-center cohort included 102 revision total hip arthroplasties performed between 2021 and 2025: standard-stem Vancouver B2 PFF (n = 44), short-stem Vancouver B2 PFF (n = 12), standard-stem nonfracture revision (n = 27), and short-stem nonfracture revision (n = 19). Primary analysis compared fracture localization and morphology between Vancouver B2 cohorts; secondary analysis compared intraoperative fractures and extraction-related reconstruction requirements between well-fixed nonfracture cohorts. Perioperative outcomes were reported descriptively.</div></div><div><h3>Results</h3><div>In Vancouver B2 PFF, short stems more frequently involved the greater trochanter (58.3%), lesser trochanter (33.3%), calcar (41.7%), and lateral cortex (58.3%) vs standard stems (40.9%, 9.1%, 13.6%, and 31.8%, respectively). During well-fixed nonfracture revision, intraoperative fracture occurred in 7/19 (36.8%) short-stem vs 4/27 (14.8%) standard-stem revisions. Cerclage fixation was required in 10/19 (52.6%) vs 4/27 (14.8%), and modular diaphyseal reconstruction in 9/19 (47.4%) vs 8/27 (29.6%), respectively.</div></div><div><h3>Conclusions</h3><div>Short and standard cementless stems showed different femoral involvement in Vancouver B2 PFF. Separately, removal of well-fixed short stems was frequently associated with extraction-related proximal femoral damage and additional fixation. These findings do not establish universal superiority of either design but emphasize considering clinical scenario, fixation pattern, and stem geometry independently when planning revision THA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"41 ","pages":"Article 102150"},"PeriodicalIF":2.1000,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroplasty Today","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352344126001998","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/10/9 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Short-stem total hip arthroplasty is increasingly used because of its bone-preserving, minimally invasive concept. Revision may occur in two fundamentally different situations: Vancouver B2 periprosthetic femoral fracture (PFF) with an unstable stem or removal of a well-fixed osseointegrated stem for a nonfracture indication. This study evaluated whether stem design is associated with distinct fracture morphology and extraction-related femoral damage.

Methods

This retrospective two-center cohort included 102 revision total hip arthroplasties performed between 2021 and 2025: standard-stem Vancouver B2 PFF (n = 44), short-stem Vancouver B2 PFF (n = 12), standard-stem nonfracture revision (n = 27), and short-stem nonfracture revision (n = 19). Primary analysis compared fracture localization and morphology between Vancouver B2 cohorts; secondary analysis compared intraoperative fractures and extraction-related reconstruction requirements between well-fixed nonfracture cohorts. Perioperative outcomes were reported descriptively.

Results

In Vancouver B2 PFF, short stems more frequently involved the greater trochanter (58.3%), lesser trochanter (33.3%), calcar (41.7%), and lateral cortex (58.3%) vs standard stems (40.9%, 9.1%, 13.6%, and 31.8%, respectively). During well-fixed nonfracture revision, intraoperative fracture occurred in 7/19 (36.8%) short-stem vs 4/27 (14.8%) standard-stem revisions. Cerclage fixation was required in 10/19 (52.6%) vs 4/27 (14.8%), and modular diaphyseal reconstruction in 9/19 (47.4%) vs 8/27 (29.6%), respectively.

Conclusions

Short and standard cementless stems showed different femoral involvement in Vancouver B2 PFF. Separately, removal of well-fixed short stems was frequently associated with extraction-related proximal femoral damage and additional fixation. These findings do not establish universal superiority of either design but emphasize considering clinical scenario, fixation pattern, and stem geometry independently when planning revision THA.

查看原文本刊更多论文

短柄与标准无骨水泥柄的骨折形态和拔出相关股骨损伤：温哥华B2骨折和良好固定的非骨折修正的分析

背景：短柄全髋关节置换术由于其保骨、微创的概念而越来越多地被应用。两种完全不同的情况下可能会进行翻修：温哥华B2假体周围股骨骨折（PFF）伴不稳定椎体或为非骨折指征切除固定良好的骨整合椎体。本研究评估了茎杆设计是否与不同的骨折形态和拔出相关的股骨损伤有关。方法：本回顾性双中心队列纳入了2021年至2025年间进行的102例翻修全髋关节置换术：标准柄温哥华B2 PFF （n = 44）、短柄温哥华B2 PFF （n = 12）、标准柄非骨折翻修（n = 27）和短柄非骨折翻修（n = 19）。初步分析比较了温哥华B2队列的骨折定位和形态；二级分析比较了固定良好的非骨折队列的术中骨折和拔出相关重建需求。围手术期结果叙述地报道。结果在温哥华B2型PFF中，短柄累及大转子（58.3%）、小转子（33.3%）、跟骨（41.7%）和外侧皮质（58.3%）的频率高于标准柄（40.9%、9.1%、13.6%和31.8%）。在固定良好的非骨折翻修中，术中骨折发生在7/19（36.8%）短杆翻修中，4/27（14.8%）标准杆翻修中。10/19 (52.6%) vs 4/27（14.8%）需要环扣固定，9/19 (47.4%)vs 8/27（29.6%）需要模组化骨干重建。结论短柄和标准柄在温哥华B2型PFF中受累股骨不同。另外，移除固定良好的短茎通常与拔出相关的股骨近端损伤和额外固定有关。这些发现并没有建立任何一种设计的普遍优势，但强调在计划翻修THA时要独立考虑临床情况、固定模式和干的几何形状。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Arthroplasty Today Medicine-Surgery

CiteScore

2.90

自引率

0.00%

发文量

258

审稿时长

40 weeks

期刊介绍： Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.