title: Revision hip arthroplasty as a treatment of Vancouver B3 periprosthetic femoral fractures without bone grafting.
abstract: BACKGROUND
  It is conventionally considered that bone grafting is mandatory for Vancouver B3 periprosthetic femoral fractures (PFF) although few clinical studies have challenged the concept previously. The aim of the current study was to investigate the radiographic and functional results of Vancouver B3 PFF treated by revision total hip or hemiarthroplasty (HA) in combination with appropriate internal fixation without bone grafting.
  
  
  METHODS
  12 patients with Vancouver B3 PFF were treated by revision THA/HA without bone grafting between March 2004 and May 2008. There were nine females and three males, with an average age of 76 years. PFFs were following primary THA/HA in nine patients and following revision THA/HA in three. Postoperative followup was 5.5 years on average (range, 3.5-6.5 years). At the final followup, radiographic results were evaluated with Beals and Tower's criteria and functional outcomes were evaluated using the Merle d'Aubigné scoring system.
  
  
  RESULTS
  All fractures healed within an average of 20 weeks (range, 12-28 weeks). There was no significant deformity and shortening of the affected limb and the implant was stable. The average Merle d'Aubigné score was 15.8. Walking ability was regained in 10 patients without additional assistance, while 2 patients had to use crutches. There were 2 patients with numbness of lateral thigh, possibly due to injury to the lateral femoral cutaneous nerve. There were no implant failures, dislocation and refractures.
  
  
  CONCLUSIONS
  Revision THA/HA in combination with appropriate internal fixation without bone grafting is a good option for treatment of Vancouver B3 periprosthetic femoral fractures in the elderly.
authors.affiliation: Department of Orthopedic Surgery, Tongji Hospital, Tongji University, Shanghai 200065, China.
authors.forename: Jia-Qi
authors.initials: JQ
authors.lastname: Wang
authors.forename: You-Shui
authors.initials: YS
authors.lastname: Gao
authors.forename: Jiong
authors.initials: J
authors.lastname: Mei
authors.forename: Zhi-Tao
authors.initials: ZT
authors.lastname: Rao
authors.forename: Shu-Qing
authors.initials: SQ
authors.lastname: Wang
keywords: Periprosthetic femoral fractures; hemiarthroplasty; internal fixation; total hip arthroplasty