SRS114 - Vancouver B2 Periprosthetic femoral fractures around cemented polished taper-slip stems—how should we treat these? A systematic scoping review and algorithm for management

Abstract Background Periprosthetic femoral fractures (PFF) are a destructive and challenging complication of hip arthroplasty surgery. The Vancouver Classification describes a B2 PFF around a loose stem with sufficient bone stock. In recent years, the number of B2 PFFs and cementation of femoral stems have increased substantially. However, there is little consensus on how best to manage these fractures. This systematic scoping review aimed to review the options and establish the first algorithm of management to treat Vancouver B2 PFFs around cemented polished taper-slip (PTS) stems. Methods This study reviewed articles reporting on Vancouver B2 PFFs around cemented femoral stems between 2012 and 2024. Data extracted included: patient demographics, index prosthesis, surgical intervention, decision for treatment, operation time, transfusion requirement, length of hospital stay, post-operative rehabilitation, mobility and radiological outcomes, complications, reoperation and mortality rates. Results Fourteen studies met all inclusion criteria including 552 cases. Treatment options included open reduction and internal fixation (ORIF), revision arthroplasty with cementless modular/monoblock long-stems ± distal locking, cement-in-cement revision and cemented long-stem revision ± impaction bone grafting. An algorithm was produced to determine factors for consideration in optimising pre-operative planning. Conclusions and implications Management of B2 PFFs around cemented PTS stems is complex and aims to obtain stable fracture and stem fixation. Options include ORIF, cement-in-cement and cementless revision. The optimal choice depends on a combination of patient, fracture and surgeon factors recommended in the algorithm. This review has proposed the first algorithm to aid in operative decision making for all grades of orthopaedic surgeon.