Article
Revision Arthroplasty versus Open Reduction and Internal Fixation in Vancouver B2- & B3-type Periprosthetic Femur Fractures: A Systematic Review and Meta-analysis of Reported Clinical and Radiological Outcome
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Authors
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Thomas Haider
- Medizinische Universität Wien, Wien, Austria
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Philip Hanna
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States
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Amin Mohamadi
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States
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Nelson Merchan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States
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Megan McNichol
- Beth Israel Deaconess Medical Center, Boston, United States
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Edward K. Rodriguez
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States
| Published: | October 26, 2021 |
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Outline
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Objectives: To compare reported clinical and radiological outcome between open reduction internal fixation (ORIF) and revision arthroplasty (RA) in Vancouver B2 & B3-type periprosthetic femur fractures.
Methods: In accordance with PRISMA guidelines, databases including Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Studies published in English and a minimum reported follow-up of 30 days were included. Study selection was followed by quality assessment using the MINORS criteria. Based on data heterogeneity either random- or fixed-effects meta-analysis was performed to compare both treatment cohorts.
Results and Conclusion: In total, 33 studies with 2,509 patients with Vancouver B2 and B3 periprosthetic femur fractures were included. Overall, complication rates did not differ between the 2 treatment groups (28.9% vs 17.8%, p=0.135). Both, re-operation (22.9% vs 13.5%, p<0.01) and femoral stem revision rates (12% vs. 3%, p<0.01) were significantly higher in ORIF treated patients. However, sub-group analyses including only B2-type fractures failed to demonstrate any differences in re-operation (21 vs. 14%, p=0.26) nor femoral component revision rates (7% vs. 5%, p=0.59). Overall, no significant differences in clinical outcome and mortality were found between the 2 treatment groups.
Meta-analysis of available literature revealed comparable results for both ORIF and RA treatment in Vancouver B2 periprosthetic femur fractures while in Vancouver B3 fractures RA was associated with lower complication and revision rates.
