title: Cement-in-cement stem revision for Vancouver type B periprosthetic femoral fractures after total hip arthroplasty. A 3-year follow-up of 23 cases.
abstract: OBJECTIVE
  Revision surgery for periprosthetic femoral fractures around an unstable cemented femoral stem traditionally requires removal of existing cement. We propose a new technique whereby a well-fixed cement mantle can be retained in cases with simple fractures that can be reduced anatomically when a cemented revision is planned. This technique is well established in femoral stem revision, but not in association with a fracture.
  
  
  METHODS
  We treated 23 Vancouver type B periprosthetic femoral fractures by reducing the fracture and cementing a revision stem into the pre-existing cement mantle, with or without supplementary fixation.
  
  
  RESULTS
  3 patients died in the first 6 months for reasons unrelated to surgery. In addition, 1 was too frail to attend follow-up and was therefore excluded from the study, and 1 patient underwent revision surgery for a nonunion. The remaining 18 cases all healed with radiographic union after an average time of 4.4 (2-11) months. There was no sign of loosening or subsidence of the revision stems within the old cement mantle in any of these cases at the most recent follow-up after an average of 3 (0.3-9) years.
  
  
  CONCLUSIONS
  Our results support the use of the cement-in-cement revision in anatomically reducible periprosthetic fractures with a well-preserved pre-existing cement mantle. This technique is particularly useful for the elderly patient and for those who are not fit for prolonged surgical procedures.
authors.affiliation: Queen Alexandra Hospital, Portsmouth, UK. tbriantevans@hotmail.com
authors.forename: Toby W
authors.initials: TW
authors.lastname: Briant-Evans
authors.forename: Darmaraja
authors.initials: D
authors.lastname: Veeramootoo
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Tsiridis
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hubble
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D001843:Bone Cements; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005500:Follow-Up Studies; D017102:Fracture Healing; D016330:Frail Elderly; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011475:Prosthesis Failure; D012086:Reoperation
chemical_list: D001843:Bone Cements