Successful Conservative Treatment for Vancouver Type B3 Periprosthetic Femoral Fracture after Total Hip Arthroplasty: A Case Report.

Abstract

Periprosthetic femoral fractures after total hip arthroplasty (THA) are increasing, though Vancouver type B3 fractures-characterized by a loose femoral stem and poor bone stock-are generally considered unsuitable for conservative treatment. We report a rare case of successful conservative management in a 79‑year‑old woman who sustained a Vancouver type B3 fracture 12 years after conversion of hip arthrodesis to THA. Severe cardiac dysfunction (ejection fraction 30%) precluded surgical intervention, and long‑term non‑weight bearing with physiotherapy was adopted. After 20 months, the patient wished to regain independent ambulation, and a carefully monitored rehabilitation program with gradual weight bearing was initiated. Muscle strength improved steadily, and radiographs confirmed fracture union and stem stability. Ultimately, the patient regained the ability to walk independently with a pick‑up walker. This case highlights that, although extremely rare, conservative treatment combined with sustained exercise therapy may achieve favorable outcomes in selected patients with Vancouver type B3 fractures when surgery is contraindicated.