title: Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures.
abstract: BACKGROUND
  Surgeons have several implant choices when managing Vancouver B2 and B3 periprosthetic fractures about the hip. Few long-term studies have reported outcomes for tapered fluted titanium stems.
  
  
  OBJECTIVE
  We determined (1) survival, with femoral revision as the end point, of distal taper stems in the treatment of Vancouver B2 and B3 periprosthetic fractures at our institution, (2) radiographic outcomes, and (3) quality of life and hip function after revision.
  
  
  METHODS
  Of the 200 patients with Vancouver B2 or B3 periprosthetic fractures treated with femoral revision between February 2000 and February 2010, 55 (38 B2, 17 B3) were treated with modular tapered titanium stems. Of the surviving 47 patients, one was lost to followup, leaving 46 (30 B2, 16 B3) available for review at a mean of 54 months (range, 24-143 months). Initial indications for using these implants were treatment of periprosthetic fractures where less than 4 cm of diaphyseal fit was available, but this evolved during the study period to all fractures unless no diaphysis remained, in which case complex revision techniques were used. Radiographs were assessed to establish fracture healing, stem subsidence, and bone stock restoration. Quality of life and hip function were assessed using WOMAC, Oxford, SF-12, UCLA activity level, and satisfaction scores.
  
  
  RESULTS
  Two femoral stems were revised: one subsided and was revised at 12 months; the other had deep infection and underwent two-stage revision at 49 months. Radiographic review showed one nonunion, with maintenance or improvement of bone stock in 89% of patients. Subsidence occurred in 24%. Mean Oxford score was 76 of 100, WOMAC function and pain scores were 75 and 82 of 100, satisfaction score was 91 of 100, and SF-12 mental and physical scores were 53 and 40 of 100.
  
  
  CONCLUSIONS
  We report encouraging short-term results in terms of survival of distal taper stems in the treatment of B2 and B3 periprosthetic fractures. Although subsidence was frequent, most migrated less than 3 mm without correlation to poor pain and functional scores.
authors.affiliation: Department of Orthopaedics, University of British Columbia, 910 West 10th Avenue, Room 3114, Vancouver, BC, V5Z 4E3, Canada.
authors.forename: Jacob T
authors.initials: JT
authors.lastname: Munro
authors.forename: Donald S
authors.initials: DS
authors.lastname: Garbuz
authors.forename: Bassam A
authors.initials: BA
authors.lastname: Masri
authors.forename: Clive P
authors.initials: CP
authors.lastname: Duncan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation*; D001696:Biomechanical Phenomena; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005592:Fracture Fixation / Q000009:adverse effects / Q000295:instrumentation*; D017102:Fracture Healing; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D057068:Periprosthetic Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery; D011859:Radiography; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D014025:Titanium