Skip to main content
Download PDF

The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) - a systematic review

BMC Musculoskeletal Disorders volume 23, Article number: 280 (2022) Cite this article

Abstract

Background

Periprosthetic femoral fractures (PFFs) represent a major cause for surgical revision after hip arthroplasty with detrimental consequences for patients. The Vancouver classification has been traditionally used since its introduction in 1995. The Unified Classification System (UCS) was described in 2014, to widen the spectrum by aiming for a more comprehensive approach. The UCS also aimed to replace the Vancouver classification by expanding the idea of the Vancouver classification to the whole musculoskeletal apparatus. After introduction of the UCS, the question was raised, whether the UCS found its place in the field of analysing PFFs. Therefore, this systematic review was performed to investigate, the use of the UCS compared to the established Vancouver classification.

Methods

Medline was searched for reports published between 1 January 2016 and 31 November 2020, without language restriction. Included were original articles, irrespective of the level of evidence and case reports reporting on a PFF and using either the Vancouver or the UCS to classify the fractures. Excluded were reviews and systematic reviews.

Results

One hundred forty-six studies were included in the analysis. UCS has not been used in a single registry study, giving a pooled cohort size of 3299 patients, compared to 59,178 patients in studies using the Vancouver classification. Since 2016, one study using UCS was published in a top journal, compared to 37 studies using the Vancouver classification (p=0.29). During the study period, the number of yearly publications remained stagnant (p=0.899).

Conclusions

Despite valuable improvement and expansion of the latter UCS, to date, the Vancouver system clearly leads the field of classifying PFFs in the sense of the common use.

Peer Review reports

Introduction

Periprosthetic femoral fractures (PFFs) are one of the main causes for revision after hip arthroplasty, with an incidence ranging from 6.6-18% [1,2,3,4]. Furthermore, the incidence of periprosthetic femoral fractures is expected to increase by up to 4.6% per decade [1, 5,6,7,8] to a cumulative incidence of almost 5% [9]. PFFs can have detrimental consequences for the patient with a mortality rate of up to 11% within 1 year after surgical treatment [10]. They also represent a substantial economic burden [7, 11]. One of the key aspects after the diagnosis of PFF is the classification of the fracture, due to its therapeutic consequence, but also, development of further treatment options and comparison between specialized centres dealing with this issue [7].

The Vancouver classification, introduced in 1995 [12], is the first comprehensive approach, that clearly defines injury patterns and treatment options for this injury [13]. The classification encompasses the location of the fracture relative to the implant, the fixation of the implant to the bone after the fracture has occurred and it assesses the bone quality. Basically, this classification distinguishes A, B and C cases. “A” cases describe fractures in the intertrochanteric area, the prosthesis is considered stable. “A” cases can be subdivided into “Al”(lesser) and “Ag”(greater) entities depending on whether the lesser or the greater trochanter is involved. “B“cases describe diaphyseal fractures around or just below the prosthesis stem, the prosthesis is considered stable and unstable as well depending on the subtype. “B” cases can be subdivided into “B1”(stable stem), “B2”(loose stem) and “B3”(loose stem and substantial bone loss). “C” cases describe fractures distinct below the prosthesis stem, the prosthesis is considered stable [12]. It has been demonstrated to be valid and reproducible [1, 14]. Finally, it also provides treatment recommendations [13]. However, in concordance with the continuous increase of arthroplasty procedures [7], the occurrence of new fracture patterns came to evidence [3, 15]. As a consequence, the Unified Classification System (UCS) was introduced in 2014, expanding the idea of the well-articulated Vancouver classification to the whole musculoskeletal system [16]. Resting on the basic principle of the Vancouver classification, it additionally contains the description of interprosthetic fractures and it also comprises acetabular fractures. Thus additional modifiers were added to the Vancouver classification. A case “D” describes an interprosthetic fracture, a case “E” describes fractures of two bones supporting one prosthesis and a case “F” a fractured bone that is unreplaced but articulating with a prosthesis [17]. As the name suggests, the Unified classification was introduced to "unify" and therefore replace all eponymous classifications. Since the PPFFs are the most common type of periprosthetic fractures [18] and the UCS covers the same nomenclatural algorithm as the Vancouver classification, the UCS aims to be the most conclusive classification to describe PPFFs. Both classifications, the Vancouver system and the UCS as well, show comparable values of validity and reliability in their use, two important variables when it comes to the usability of a classification system [1, 13, 16, 19, 20]. Despite the overlapping characterizations of these classifications, it was expected that the UCS would find a definitive place in the algorithms of patient care [17]. The purpose of this systematic review was to answer this question performing a comparison, investigating the frequency of these 2 classifications for the description of PPFFs found in the orthopaedic literature.

Material and methods

Search strategy

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines [21]. Medline was searched for reports published between 1 January 2016 and 31 November 2020, without a language restriction. Although the UCS was proposed in 2014, we decided to exclude papers before 2016, to allow the centres to get familiar with the UCS. We included original articles, irrespective of the level of evidence, and case reports reporting on a PPFF and using either the Vancouver or the UCS to classify the fractures. We excluded reviews and systematic reviews. The search queries were: (periprosthetic) AND (fracture);((periprosthetic) AND (fracture)) AND (Vancouver););((periprosthetic) AND (fracture)) AND (unified). The search results were imported into Zotero (George Mason University, Fairfax, VA, U.S.) and duplicates excluded. The titles and abstracts were screened for the inclusion and exclusion criteria. Full texts of the included studies were accessed to retrieve the following information: Author, year of publication, size of the cohort, length of follow-up, study type (clinical, case report, biomechanical, validation, instructional) and the classification used. Finally, we investigated, whether the study has been published in the top 10% of its category in the year of its release according to the Journal Citation Reports (Clarivate Analytics, Philadelphia, PA, U.S.). References of retrieved articles were manually screened. The full list of all included studies is shown in Table 1.

Table 1 List of all included studies
Full size table

Data analysis

Cohort sizes were pooled for each classification and descriptively compared. Changes in the yearly number of publications were compared using the Log-Rank (Mantel Cox) test. The ratio of publications in top 10% of journals was compared using the chi-square analysis. JASP 0.14.1 (University of Amsterdam, the Netherlands) was used for the statistical analysis.

Results

After running the search strategy, and exclusion of duplicates, 146 studies were included for the analysis, coming from centres in 29 countries on 6 continents (Fig 1). The Unified Classification was used in 9/145 studies (6.2%). UCS has not been used in a single registry study, giving a pooled cohort size of 3299 patients, compared to 59,178 patients in the studies using the Vancouver classification. Since 2016, one study using UCS was published in a top journal, compared to 37 studies using the Vancouver classification (p=0.29). During the study period, the number of yearly publications remained stagnant, (p=0.899) (Fig 2).

Fig. 1
figure 1

Consort diagram

Full size image
Fig. 2
figure 2

Comparison of yearly publications with Vancouver and Unified Classification between 2016 and 2020

Full size image

Discussion

This systematic review investigating the usage of PPFF classifications in the orthopaedic literature demonstrates that in the majority of the studies (93.8%) published since 2016 the Vancouver classification was used. Furthermore, a tendency of relevant change could not be found.

The UCS found a place in the treatment algorithms but for the most common periprosthetic fracture-the proximal femoral periprosthetic fracture-the Vancouver system remains the standard reporting classification. Although the difference is found literally in the name only and both the Vancouver and the UCS show comparable values of reliability and validity [1, 13, 16, 19, 20], it remains unclear whether the orthopaedic community is unaware of the UCS or simply “sticks” with the longer known system.

The UCS has been claimed to have had replaced the historic classifications of periprosthetic fractures [159]. This study demonstrates that this is not the case for the most common periprosthetic fracture, the PPFF. The Vancouver classification, introduced in 1995, was the first classification system to comprehensively describe periprosthetic femoral fractures including the location of the fracture with respect to the prosthesis, the bone quality of the involved bone and the information about the bony anchorage of the prosthesis [12]. The UCS aims to utilize these usable features for the whole extremity skeleton, but it still doesn’t keep up with the Vancouver classification regarding the quantitatively most important issue of the periprosthetic femoral fractures, as the latter is the most commonly used classification for the description of periprosthetic femoral fractures up to now [7].

Another reason why the UCS has been not seeing the expected usage in the literature lies to our minds in the fact that it also covers fractures of higher complexity like the description of interprosthetic fractures. Revealingly the expanded nomenclature offered by the UCS was used in only 9,6% of the clinical cases reported in our work. The incidence of the more complex PPFF cases- UCS E, D and F- is low. Since the expansion to more complex cases are the only difference to the Vancouver classification as far as the femur is concerned, this can be interpreted as an additional hindrance for the use of the UCS.

A very interesting aspect about the UCS is found in its expansion dealing with the recently added B2 type fractures involving the greater and the lesser trochanter introduced by Huang et al. These patterns were initially described by Mallory et al in 1989 [3, 15, 29, 160,161,162]. This expansion of the classification allows the user to more comprehensively describe the patterns involving the medial cortical wall in the case of a lesser trochanteric avulsion fracture around an implant. The stability of the medial cortical wall can be therefore classified, possibly leading to a therapeutic consequence. The modified version of the UCS also shows a higher grade of validity compared to the original classification, reaching a value of 89,8% compared to 79,7% [16]. This expansion was introduced, as the authors experienced a lack of ability to clearly distinguish between stable and unstable UCS type B fractures. The update aims to clarify the differentiation between stable and unstable cases [3], an attempt, that we doubt, as the decision still remains experience and user dependent.

The Vancouver classification on the other hand, was initially introduced for description of periprosthetic femoral fractures around a cemented stem [12]. Indeed, this classification shows high values of inter- and intraobserver reliability, but in some cases, it remains unclear, whether a cemented or cementless stem was used [13, 163, 164]. In contrast to validity values of up to 80% [13, 150, 163, 164], 25% of Vancouver type B fractures radiologically classified as stable (B1), appeared unstable intraoperatively (B2) [164]. The works of Corten et al and Lee et al also indicate that the utilization of the Vancouver classification tendential leads to misinterpretation of unstable type B cases as supposed stable findings. Both works showed a failure rate of 20% (9 out of 45 in both studies), when radiologically determined, supposed stable cases came to evidence as unstable cases intraoperatively [150, 165]. Additional works proof this tendency [166, 167]. In connection with the UCS, the ambiguity regarding the use of cemented or cementless stems becomes apparent as well [17, 19]. Some authors see potential for improvement for both classifications in this regard [150]. The authors in fact raise a doubt on the reliability of a radiologic classification used as a tool for stability assessment of a cementless, femoral stem in case of a periprosthetic femoral fracture [150]. We agree with this observation.

Furthermore, it has to be mentioned, that, although the UCS comprises an expansion of the Vancouver system, some authors still discover findings in a collective of periprosthetic femoral fractures, that are not classifiable under the use of the UCS [3]. In addition, this classification is claimed to be largely dependent on the subjective judgement of the user, especially regarding the implant stability and estimation of bone loss as well [3]. Classifying a fracture as B1 or B2 has led to a development of an algorithm, that should help with the decision of the integrity of the cement mantle and the resulting, therapeutic consequence [168].

Conclusion

Despite valuable improvements and expansion added by the Unified Classification System to date the Vancouver classification remains the leading classification for reporting of proximal periprosthetic femoral fractures in the orthopaedic literature. Both classifications have their weaknesses due to the dependence on user experience, subjectivity or vagueness, especially when it comes to the differentiated assessment of cemented and cementless procedures.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. De Meo D, Zucchi B, Castagna V, Pieracci EM, Mangone M, Calistri A, et al. Validity and reliability of the Unified Classification System applied to periprosthetic femur fractures: a comparison with the Vancouver system. Curr Med Res Opin. 2020;36(8):1375–81.

    PubMed  Article  Google Scholar 

  2. Capone A, Congia S, Civinini R, Marongiu G. Periprosthetic fractures: epidemiology and current treatment. Clin Cases Miner Bone Metab. 2017;14(2):189–96.

    PubMed  PubMed Central  Article  Google Scholar 

  3. Huang JF, Jiang XJ, Shen JJ, Zhong Y, Tong PJ, Fan XH. Modification of the Unified Classification System for periprosthetic femoral fractures after hip arthroplasty. J Orthop Sci. 2018;23(6):982–6.

    PubMed  Article  Google Scholar 

  4. Abdel MP, Watts CD, Houdek MT, Lewallen DG, Berry DJ. Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Joint J. 2016;98-B(4):461–7.

    CAS  PubMed  Article  Google Scholar 

  5. Haddad FS, Duncan CP, Berry DJ, Lewallen DG, Gross AE, Chandler HP. Periprosthetic femoral fractures around well-fixed implants: use of cortical onlay allografts with or without a plate. J Bone Joint Surg Am. 2002;84(6):945–50.

    PubMed  Article  Google Scholar 

  6. Pike J, Davidson D, Garbuz D, Duncan CP, O'Brien PJ, Masri BA. Principles of treatment for periprosthetic femoral shaft fractures around well-fixed total hip arthroplasty. J Am Acad Orthop Surg. 2009;17(11):677–88.

    PubMed  Article  Google Scholar 

  7. Stoffel K, Blauth M, Joeris A, Blumenthal A, Rometsch E. Fracture fixation versus revision arthroplasty in Vancouver type B2 and B3 periprosthetic femoral fractures: a systematic review. Arch Orthop Trauma Surg. 2020;140(10):1381–94.

    PubMed  PubMed Central  Article  Google Scholar 

  8. Yoon BH, Lee YK, Jo WL, Ha YC, Choi DH, Koo KH. Incidence and risk period of periprosthetic femoral fracture after cementless bipolar hemiarthroplasty in elderly patients. J Arthroplasty. 2016;31(6):1326–30.

    PubMed  Article  Google Scholar 

  9. Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, et al. Prevalence of Total Hip and Knee Replacement in the United States. J Bone Joint Surg Am. 2015;97(17):1386–97.

    PubMed  Article  Google Scholar 

  10. Bhattacharyya T, Chang D, Meigs JB, Estok DM, Malchau H. Mortality after periprosthetic fracture of the femur. J Bone Joint Surg Am. 2007;89(12):2658–62.

    PubMed  Article  Google Scholar 

  11. Phillips JR, Boulton C, Morac CG, Manktelov AR. What is the financial cost of treating periprosthetic hip fractures? Injury. 2011;42(2):146–9.

    CAS  PubMed  Article  Google Scholar 

  12. Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect. 1995;44:293–304.

    CAS  PubMed  Google Scholar 

  13. Brady OH, Garbuz DS, Masri BA, Duncan CP. The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty. 2000;15(1):59–62.

    CAS  PubMed  Article  Google Scholar 

  14. Bates BD, Walmsley DW, Vicente MR, Kuzyk PR, Nauth A, Waddell JP, et al. An international, cross-sectional survey of the management of Vancouver type B1 periprosthetic femoral fractures around total hip arthroplasties. Injury. 2018;49(2):364–9.

    PubMed  Article  Google Scholar 

  15. Huang JF, Shen JJ, Chen JJ, Zheng Y, Du WX, Liu FC, et al. New fracture pattern focusing on implant fracture for periprosthetic femoral fractures. Int Orthop. 2015;39(9):1765–9.

    PubMed  Article  Google Scholar 

  16. Fan MQ, Fan XH, Chen XL, Shen JJ, Jiang XJ, Li XS, Huang JF. The reliability and validity of the modified Unified Classification System for periprosthetic femoral fractures after hip arthroplasty. J Orthop Sci. 2021;26(3):385-8.

  17. Duncan CP, Haddad FS. The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J. 2014;96-B(6):713–6.

    CAS  PubMed  Article  Google Scholar 

  18. Della Rocca GJ, Leung KS, Pape HC. Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma. 2011;25(Suppl 2):S66–70.

    PubMed  Article  Google Scholar 

  19. Vioreanu MH, Parry MC, Haddad FS, Duncan CP. Field testing the Unified Classification System for peri-prosthetic fractures of the pelvis and femur around a total hip replacement : an international collaboration. Bone Joint J. 2014;96-b(11):1472–7.

    CAS  PubMed  Article  Google Scholar 

  20. Huang JF, Chen JJ, Shen JJ, Du WX, Liu FC, Tong PJ. The reliability and validity of the Unified Classification System of periprosthetic femoral fractures after hip arthroplasty. Acta Orthop Belg. 2016;82(2):233–9.

    PubMed  Google Scholar 

  21. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9 W264.

    PubMed  Article  Google Scholar 

  22. Rupp M, Kern S, Ismat A, El Khassawna T, Knapp G, Szalay G, et al. Computed tomography for managing periprosthetic femoral fractures. A retrospective analysis. BMC Musculoskelet Disord. 2019;20(1):258.

    PubMed  PubMed Central  Article  Google Scholar 

  23. Gunther T, Farkashazi M, Mihalik G, Nyoger Z, Kovacs T. Functional outcome after lower limb periprosthetic fractures. Injury. 2020.

  24. Nagwadia H, Joshi P. Outcome of osteosynthesis for periprosthetic fractures after total knee arthroplasty: a retrospective study. Eur J Orthop Surg Traumatol. 2018;28(4):683–90.

    PubMed  Article  Google Scholar 

  25. Kim MB, Cho JW, Lee YH, Shon WY, Park JW, Kim J, et al. Locking attachment plate fixation around a well-fixed stem in periprosthetic femoral shaft fractures. Arch Orthop Trauma Surg. 2017;137(9):1193–200.

    PubMed  Article  Google Scholar 

  26. Yeo I, Rhyu KH, Kim SM, Park YS, Lim SJ. High union rates of locking compression plating with cortical strut allograft for type B1 periprosthetic femoral fractures. Int Orthop. 2016;40(11):2365–71.

    PubMed  Article  Google Scholar 

  27. Manara JR, Mathews JA, Sandhu HS. Cable plating with a single strut allograft in the treatment of periprosthetic fractures of the femur. Hip Int. 2019;29(1):58–64.

    PubMed  Article  Google Scholar 

  28. Diaz-Dilernia F, Slullitel PA, Oñativia JI, Comba FM, Piccaluga F, Buttaro MA. Impaction bone grafting or uncemented modular stems for the treatment of type B3 periprosthetic femoral fractures? a complication rate analysis. J Arthroplasty. 2019;34(9):2051–7.

    PubMed  Article  Google Scholar 

  29. Karam J, Campbell P, Desai S, Hunter M. Periprosthetic proximal femoral fractures in cemented and uncemented stems according to Vancouver classification: observation of a new fracture pattern. J Orthop Surg Res. 2020;15(1):100.

    PubMed  PubMed Central  Article  Google Scholar 

  30. Smitham PJ, Carbone TA, Bolam SM, Kim YS, Callary SA, Costi K, et al. Vancouver B2 Peri-Prosthetic fractures in cemented femoral implants can be treated with open reduction and internal fixation alone without revision. J Arthroplasty. 2019;34(7):1430–4.

    PubMed  Article  Google Scholar 

  31. Stevens J, Clement N, Nasserallah M, Millar M, Joseph S. Femoral cortical thickness influences the pattern of proximal femoral periprosthetic fractures with a cemented stem. Eur J Orthop Surg Traumatol. 2018;28(4):659–65.

    PubMed  Article  Google Scholar 

  32. Gordon K, Winkler M, Hofstädter T, Dorn U, Augat P. Managing Vancouver B1 fractures by cerclage system compared to locking plate fixation - a biomechanical study. Injury. 2016;47(Suppl 2):S51–7.

    PubMed  Article  Google Scholar 

  33. Joestl J, Hofbauer M, Lang N, Tiefenboeck T, Hajdu S. Locking compression plate versus revision-prosthesis for Vancouver type B2 periprosthetic femoral fractures after total hip arthroplasty. Injury. 2016;47(4):939–43.

    PubMed  Article  Google Scholar 

  34. Lang NW, Joestl J, Payr S, Platzer P, Sarahrudi K. Secondary femur shaft fracture following treatment with cephalomedullary nail: a retrospective single-center experience. Arch Orthop Trauma Surg. 2017;137(9):1271–8.

    PubMed  Article  Google Scholar 

  35. Thaler M, Dammerer D, Krismer M, Ban M, Lechner R, Nogler M. Extension of the Direct Anterior Approach for the Treatment of Periprosthetic Femoral Fractures. J Arthroplasty. 2019;34(10):2449-53.

  36. Trieb K, Fiala R, Briglauer C. Midterm results of consecutive periprosthetic femoral fractures vancouver type A and B. Clin Pract. 2016;6(3):871.

    PubMed  PubMed Central  Article  Google Scholar 

  37. Ghijselings S, Simon JP, Corten K. Is there a place for conservative treatment of a Vancouver B2 fracture around a cemented polished tapered stem? Acta Orthop Belg. 2018;84(3):292–7.

    PubMed  Google Scholar 

  38. Aleem IS, Bhandari M, Elizalde SR. Early definitive fixation of an open periprosthetic femur fracture in the polytraumatized patient: a case report and review of the literature. J Orthop Case Rep. 2016;6:33–6.

    PubMed  PubMed Central  Google Scholar 

  39. Herman A, Masri BA, Duncan CP, Greidanus NV, Garbuz DS. Multivariate analysis of risk factors for re-dislocation after revision for dislocation after total hip arthroplasty. Hip Int. 2020;30(1):93–100.

    PubMed  Article  Google Scholar 

  40. Lochab J, Carrothers A, Wong E, McLachlin S, Aldebeyan W, Jenkinson R, et al. Do transcortical screws in a locking plate construct improve the stiffness in the fixation of vancouver B1 periprosthetic femur fractures? A biomechanical analysis of 2 different plating constructs. J Orthop Trauma. 2017;31(1):15–20.

    PubMed  Article  Google Scholar 

  41. Li D, Hu Q, Kang P, Yang J, Zhou Z, Shen B, et al. Reconstructed the bone stock after femoral bone loss in Vancouver B3 periprosthetic femoral fractures using cortical strut allograft and impacted cancellous allograft. Int Orthop. 2018;42(12):2787–95.

    PubMed  Article  Google Scholar 

  42. Sun JN, Zhang Y, Zhang JM, Chen XY, Feng S. Mid- and long-term efficacy of surgical treatment of Vancouver B2 and B3 periprosthetic femoral fractures. BMC Surg. 2020;20(1):226.

    PubMed  PubMed Central  Article  Google Scholar 

  43. Wang Q, Li D, Kang P. Uncemented extensive porous titanium-coated long femoral stem prostheses are effective in treatment of Vancouver type B2 periprosthetic femoral fractures: A retrospective mid- to long-term follow-up study. J Orthop Surg (Hong Kong). 2019;27(2):2309499019857653.

    Google Scholar 

  44. Wang QR, Yeersheng R, Li DH, Yang ZY, Kang PD. Intravenous tranexamic acid for reducing perioperative blood loss during revision surgery for vancouver type B periprosthetic femoral fractures after total hip arthroplasty: a retrospective study. Orthop Surg. 2020;12(1):100–7.

    PubMed  Article  Google Scholar 

  45. Zhang Z, Zhuo Q, Chai W, Ni M, Li H, Chen J. Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty: A retrospective study. Medicine (Baltimore). 2016;95(35):e4751.

    Article  Google Scholar 

  46. Zheng H, Gu H, Shao H, Huang Y, Yang D, Tang H, et al. Treatment and outcomes of Vancouver type B periprosthetic femoral fractures. Bone Joint J. 2020;102-b(3):293–300.

    PubMed  Article  Google Scholar 

  47. Pavelka T, Salášek M, Weisová D. Periprosthetic femoral fractures after total hip replacement: our results and treatment complications. Acta Chir Orthop Traumatol Cech. 2017;84(1):52–8.

    CAS  PubMed  Google Scholar 

  48. Gromov K, Bersang A, Nielsen CS, Kallemose T, Husted H, Troelsen A. Risk factors for post-operative periprosthetic fractures following primary total hip arthroplasty with a proximally coated double-tapered cementless femoral component. Bone Joint J. 2017;99-b(4):451–7.

    CAS  PubMed  Article  Google Scholar 

  49. Andriamananaivo T, Odri GA, Ollivier M, Mattesi L, Renault A, Rongieras F, et al. Contribution of the remaining attachment index in the management of Vancouver B1 periprosthetic hip fracture. Orthop Traumatol Surg Res. 2020;106(7):1413–7.

    PubMed  Article  Google Scholar 

  50. Bonnevialle P, Marcheix PS, Nicolau X, Arboucalot M, Lebaron M, Chantelot C, et al. Interprosthetic femoral fractures: Morbidity and mortality in a retrospective, multicenter study. Orthop Traumatol Surg Res. 2019;105(4):579–85.

    PubMed  Article  Google Scholar 

  51. Cohen S, Flecher X, Parratte S, Ollivier M, Argenson JN. Influence of treatment modality on morbidity and mortality in periprosthetic femoral fracture. A comparative study of 71 fractures treated by internal fixation or femoral implant revision. Orthop Traumatol Surg Res. 2018;104(3):363–7.

    CAS  PubMed  Article  Google Scholar 

  52. Ehlinger M, Niglis L, Favreau H, Kuntz S, Bierry G, Adam P, et al. Vascular complication after percutaneous femoral cerclage wire. Orthop Traumatol Surg Res. 2018;104(3):377–81.

    CAS  PubMed  Article  Google Scholar 

  53. Gavanier B, Houfani F, Dumoulin Q, Bernard E, Mangin M, Mainard D. Osteosynthesis of periprosthetic type A and B femoral fractures using an unlocked plate with integrated cerclage cable and trochanteric hook: A multicenter retrospective study of 45 patients with mean follow-up of 20 months. Injury. 2017;48(12):2827–32.

    CAS  PubMed  Article  Google Scholar 

  54. Perrin A, Saab M, Putman S, Benad K, Drumez E, Chantelot C. The benefit of the systematic revision of the acetabular implant in favor of a dual mobility articulation during the treatment of periprosthetic fractures of the femur: a 49 cases prospective comparative study. Eur J Orthop Surg Traumatol. 2018;28(2):239–46.

    CAS  PubMed  Article  Google Scholar 

  55. Bellova P, Baecker H, Lotzien S, Brandt M, Schildhauer TA, Gessmann J. Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hemiarthroplasties. J Orthop Surg Res. 2019;14(1):432.

    PubMed  PubMed Central  Article  Google Scholar 

  56. Brand S, Bauer M, Petri M, Schrader J, Maier HJ, Krettek C, et al. Impact of intraprosthetic drilling on the strength of the femoral stem in periprosthetic fractures: A finite element investigation. Proc Inst Mech Eng H. 2016;230(7):675–81.

    PubMed  Article  Google Scholar 

  57. Fink B, Oremek D. Hip revision arthroplasty for failed osteosynthesis in periprosthetic Vancouver type B1 fractures using a cementless, modular, tapered revision stem. Bone Joint J. 2017;99-b(4 Supple B):11–6.

    CAS  PubMed  Article  Google Scholar 

  58. Hoffmann MF, Lotzien S, Schildhauer TA. Clinical outcome of interprosthetic femoral fractures treated with polyaxial locking plates. Injury. 2016;47(4):934–8.

    CAS  PubMed  Article  Google Scholar 

  59. Hoffmann MF, Lotzien S, Schildhauer TA. Outcome of periprosthetic femoral fractures following total hip replacement treated with polyaxial locking plate. Eur J Orthop Surg Traumatol. 2017;27(1):107–12.

    CAS  PubMed  Article  Google Scholar 

  60. Innmann MM, Streit MR, Bruckner T, Merle C, Gotterbarm T. Comparable cumulative incidence of late periprosthetic femoral fracture and aseptic stem loosening in uncemented total hip arthroplasty-a concise follow-up report at a minimum of 20 Years. J Arthroplasty. 2018;33(4):1144–8.

    PubMed  Article  Google Scholar 

  61. Klasan A, Bäumlein M, Dworschak P, Bliemel C, Neri T, Schofer MD, et al. Short stems have lower load at failure than double-wedged stems in a cadaveric cementless fracture model. Bone Joint Res. 2019;8(10):472–80.

    PubMed  PubMed Central  Article  Google Scholar 

  62. Müller M, Winkler T, Märdian S, Trampuz A, Renz N, Perka C, et al. The worst-case scenario: treatment of periprosthetic femoral fracture with coexistent periprosthetic infection-a prospective and consecutive clinical study. Arch Orthop Trauma Surg. 2019;139(10):1461–70.

    PubMed  Article  Google Scholar 

  63. Schreiner AJ, Steidle C, Schmidutz F, Gonser C, Hemmann P, Stöckle U, et al. Hip Revision Arthroplasty of Periprosthetic Fractures Vancouver B2 and B3 with a Modular Revision Stem: Short-Term Results and Review of Literature. Z Orthop Unfall. 2020.

  64. Wähnert D, Müller M, Tiedemann H, Märdian S, Raschke MJ, Kösters C. Periprosthetic fracture fixation in Vancouver B1 femoral shaft fractures: A biomechanical study comparing two plate systems. J Orthop Translat. 2020;24:150–4.

    PubMed  PubMed Central  Article  Google Scholar 

  65. Wähnert D, Grüneweller N, Gehweiler D, Brunn B, Raschke MJ, Stange R. Double plating in Vancouver type B1 periprosthetic proximal femur fractures: A biomechanical study. J Orthop Res. 2017;35(2):234–9.

    PubMed  Article  CAS  Google Scholar 

  66. Zajonz D, Pönick C, Edel M, Möbius R, Pfeifle C, Prietzel T, et al. Results after surgical treatment of periprosthetic proximal femoral fractures. Osteosynthesis with prosthesis preservation vs. prosthesis change. GMS Interdiscip Plast Reconstr Surg DGPW. 2020;9:Doc02.

    PubMed  PubMed Central  Google Scholar 

  67. Zwingmann J, Krieg M, Thielemann F, Südkamp N, Helwig P. Long-Term Function following Periprosthetic Fractures. Acta Chir Orthop Traumatol Cech. 2016;83(6):381–7.

    CAS  PubMed  Google Scholar 

  68. Walcher MG, Giesinger K, du Sart R, Day RE, Kuster MS. Plate positioning in periprosthetic or interprosthetic femur fractures with stable implants-a biomechanical study. J Arthroplasty. 2016;31(12):2894–9.

    PubMed  Article  Google Scholar 

  69. Woo SB, Choi ST, Chan WL. Atypical periprosthetic femoral fracture: a case report. J Orthop Surg (Hong Kong). 2016;24(2):269–72.

    CAS  Article  Google Scholar 

  70. Dózsai D, Ecseri T, Csonka I, Gárgyán I, Doró P, Csonka Á. Atypical periprosthetic femoral fracture associated with long-term bisphosphonate therapy. J Orthop Surg Res. 2020;15(1):414.

    PubMed  PubMed Central  Article  Google Scholar 

  71. Dhason R, Roy S, Datta S. A biomechanical study on the laminate stacking sequence in composite bone plates for vancouver femur B1 fracture fixation. Comput Methods Programs Biomed. 2020;196:105680.

    PubMed  Article  Google Scholar 

  72. Kittanakere Ramanath S, Hemant Shah R, Kaushik K. Conjoint removal of hip screw-femur head during hip replacement after previous dynamic hip screw fixation. Orthop Surg. 2018;10(4):337–42.

    PubMed  PubMed Central  Article  Google Scholar 

  73. Baig MN, Dzufar AH, Murphy CG, Curtin B. Intriguing periprosthetic fracture of hip stem and proximal femoral replacement. Cureus. 2018;10(4):e2496.

    CAS  PubMed  PubMed Central  Google Scholar 

  74. Cassidy JT, Kenny P, Keogh P. Failed osteosynthesis of cemented B1 periprosthetic fractures. Injury. 2018;49(10):1927-30.

  75. Fenelon C, Murphy EP, Baig MN, Kearns SR, Murphy CG, Curtin W. Breaking bad: a comparative descriptive analysis of periprosthetic fractures around cemented and uncemented femoral stems. J Arthroplasty. 2019;34(8):1783–6.

    PubMed  Article  Google Scholar 

  76. Sheridan GA, Galbraith A, Kearns SR, Curtin W, Murphy CG. Extended trochanteric osteotomy (ETO) fixation for femoral stem revision in periprosthetic fractures: Dall-Miles plate versus cables. Eur J Orthop Surg Traumatol. 2018;28(3):471–6.

    PubMed  Article  Google Scholar 

  77. Angelini A, Battiato C. Combination of low-contact cerclage wiring and osteosynthesis in the treatment of femoral fractures. Eur J Orthop Surg Traumatol. 2016;26(4):397–406.

    PubMed  Article  Google Scholar 

  78. Bibiano L, Stamboltsyan G, Touloupakis G, Ghirardelli S, Biancardi E, Longo GEG, et al. Plate fixation in periprosthetic femur fractures Vancouver type B1: preliminary report of macroscopic evaluation of the cement mantle and short literature review. Acta Biomed. 2019;90(1):31–6.

    PubMed  Google Scholar 

  79. Biggi S, Camera A, Tedino R, Capuzzo A, Tornago S. The value of a standardized and reproducible surgical technique in treatment of Vancouver B2 periprosthetic fractures: our experience. Eur J Trauma Emerg Surg. 2019;45(6):1031–8.

    PubMed  Article  Google Scholar 

  80. Castelli A, Rossi SMP, Rocca L, Jannelli E, Benazzo F. Treatment of Vancouver B1, C periprosthetic hip fractures with periprosthetic polyaxial locking plate system: A 3-year follow-up. J Biol Regul Homeost Agents. 2018;32(6 Suppl. 1):209–16.

    CAS  PubMed  Google Scholar 

  81. Cottino U, Dettoni F, Caputo G, Bonasia DE, Rossi P, Rossi R. Incidence and pattern of periprosthetic hip fractures around the stem in different stem geometry. Int Orthop. 2020;44(1):53–9.

    PubMed  Article  Google Scholar 

  82. Giaretta S, Momoli A, Porcelli G, Micheloni GM. Diagnosis and management of periprosthetic femoral fractures after hip arthroplasty. Injury. 2019;50(Suppl 2):S29–s33.

    PubMed  Article  Google Scholar 

  83. Munegato D, Caminita AD, Sotiri R, Rossi A, Bigoni M, Zatti G. Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes. Hip Int. 2020;30(2_suppl):101–7.

    PubMed  Article  Google Scholar 

  84. Pavone V, de Cristo C, Di Stefano A, Costarella L, Testa G, Sessa G. Periprosthetic femoral fractures after total hip arthroplasty: an algorithm of treatment. Injury. 2019;50(Suppl 2):S45–s51.

    PubMed  Article  Google Scholar 

  85. Randelli F, Pace F, Priano D, Giai Via A, Randelli P. Re-fractures after periprosthetic femoral fracture: a difficult to treat growing evidence. Injury. 2018;49(Suppl 3):S43–s47.

    PubMed  Article  Google Scholar 

  86. Solarino G, Zagra L, Piazzolla A, Morizio A, Vicenti G, Moretti B. Results of 200 consecutive ceramic-on-ceramic cementless hip arthroplasties in patients up to 50 years of age: A 5-24 years of follow-up study. J Arthroplasty. 2019;34(7s):S232–s237.

    PubMed  Article  Google Scholar 

  87. Solarino G, Piazzolla A, Moretti L, Vicenti G, Moretti B. A minimum 20-year outcome of 100 consecutive alumina-on-alumina arthroplasties performed by a single surgeon. Hip Int. 2018;28(2_suppl):10–4.

    PubMed  Article  Google Scholar 

  88. Spina M, Scalvi A. Periprosthetic fractures of the proximal femur within first year of the index hip prosthesis. Acta Biomed. 2020;91(3):e2020060.

    PubMed Central  Google Scholar 

  89. Spina M, Scalvi A. Vancouver B2 periprosthetic femoral fractures: a comparative study of stem revision versus internal fixation with plate. Eur J Orthop Surg Traumatol. 2018;28(6):1133–42.

    PubMed  Article  Google Scholar 

  90. Kamo K, Kido H, Kido S. Comparison of the Incidence of Intra-operative fractures in hip hemi-arthroplasty performed in supine and lateral positions. Hip Pelvis. 2019;31(1):33–9.

    PubMed  PubMed Central  Article  Google Scholar 

  91. Kurinomaru N, Mori T, Tsukamoto M, Okada Y, Yumisashi K, Sakai A. Case report and literature review of periprosthetic atypical femoral fractures after total hip arthroplasty. J uoeh. 2019;41(4):409–16.

    PubMed  Article  Google Scholar 

  92. Ochi H, Baba T, Tanabe H, Ozaki Y, Watari T, Homma Y, et al. Autograft-prosthesis composite use for a Vancouver type B1 periprosthetic femur fracture with pelvic acetabular component migration after bipolar hemiarthroplasty: a case report. Trauma Case Rep. 2019;22:100213.

    PubMed  PubMed Central  Article  Google Scholar 

  93. Okudera Y, Kijima H, Yamada S, Konishi N, Kubota H, Tazawa H, et al. The location of the fracture determines the better solution, osteosynthesis or revision, in periprosthetic femoral fractures. J Orthop. 2020;22:220–4.

    PubMed  PubMed Central  Article  Google Scholar 

  94. Abarquero-Diezhandino A, Toro-Ibarguen AN, Moreno-Beamud JA, Ojeda-Thies C, Delgado-Diaz E. Obturator dislocation of total hip arthroplasty with disassembly of the prosthesis components and periprosthetic fracture in morbid obese patient. Acta Ortop Mex. 2020;34(1):47–52.

    CAS  PubMed  Article  Google Scholar 

  95. Negrete-Corona J, Jiménez-Aquino JM, Pola-Rodríguez LC. Review of femoral component with proximal metaphyseal reconstruction using allograft cortical struts in a multioperated patient. Case report. Acta Ortop Mex. 2018;32(1):48–52.

    CAS  PubMed  Google Scholar 

  96. Bulatović N, Kezunović M, Vučetić Č, Abdić N, Benčić I, Čengić T. Treatment of periprosthetic femoral fractures after total hip arthroplasty vancouver Type B. Acta Clin Croat. 2017;56(3):536–43.

    PubMed  Google Scholar 

  97. Karabila MA, Bardouni A. Periprosthetic hip fracture type C Vancouver, what not to do. Pan Afr Med J. 2016;23:5.

    PubMed  PubMed Central  Google Scholar 

  98. Duijnisveld BJ, van den Hout J, Wagenmakers R, Koenraadt KLM, Bolder SBT. No learning curve of the direct superior approach in total hip arthroplasty. Orthop Surg. 2020;12(3):852–60.

    PubMed  PubMed Central  Article  Google Scholar 

  99. van Rijn J, Koper MC, Bos PK. Routine fracture fixation for a periprosthetic hip fracture below birmingham hip resurfacing: a case report. JBJS Case Connect. 2020;10(3):e1900540.

    PubMed  Article  Google Scholar 

  100. Legosz P, Platek AE, Rys-Czaporowska A, Szymanski FM, Maldyk P. Correlations between Vancouver type of periprosthetic femur fracture and treatment outcomes. J Orthop. 2019;16(6):517–21.

    PubMed  PubMed Central  Article  Google Scholar 

  101. Lorkowski J, Wilk R, Pokorski M. In silico evaluation of treatment of periprosthetic fractures in elderly patients after hip arthroplasty. Adv Exp Med Biol. 2020.

  102. Kim SM, Han SB, Rhyu KH, Yoo JJ, Oh KJ, Yoo JH, et al. Periprosthetic femoral fracture as cause of early revision after short stem hip arthroplasty-a multicentric analysis. Int Orthop. 2018;42(9):2069–76.

    PubMed  Article  Google Scholar 

  103. Kim YH, Mansukhani SA, Kim JS, Park JW. Use of locking plate and strut onlay allografts for periprosthetic fracture around well-fixed femoral components. J Arthroplasty. 2017;32(1):166–70.

    PubMed  Article  Google Scholar 

  104. Lee JM, Kim TS, Kim TH. Treatment of periprosthetic femoral fractures following hip arthroplasty. Hip Pelvis. 2018;30(2):78–85.

    PubMed  PubMed Central  Article  Google Scholar 

  105. Lee YK, Kim JT, Kim KC, Ha YC, Koo KH. Conservative Treatment for Minimally Displaced Type B Periprosthetic Femoral Fractures. J Arthroplasty. 2017;32(11):3529–32.

    PubMed  Article  Google Scholar 

  106. Min BW, Lee KJ, Cho CH, Lee IG, Kim BS. High failure rates of locking compression plate osteosynthesis with transverse fracture around a well-fixed stem tip for periprosthetic femoral fracture. J Clin Med. 2020;9(11).

  107. Min BW, Cho CH, Son ES, Lee KJ, Lee SW, Min KK. Minimally invasive plate osteosynthesis with locking compression plate in patients with Vancouver type B1 periprosthetic femoral fractures. Injury. 2018;49(7):1336–40.

    PubMed  Article  Google Scholar 

  108. Park JS, Moon KH. Medium- to long-term results of strut allografts treating periprosthetic bone defects. Hip Pelvis. 2018;30(1):23–8.

    PubMed  PubMed Central  Article  Google Scholar 

  109. Park JS, Hong S, Nho JH, Kang D, Choi HS, Suh YS. Radiologic outcomes of open reduction and internal fixation for cementless stems in Vancouver B2 periprosthetic fractures. Acta Orthop Traumatol Turc. 2019;53(1):24–9.

    PubMed  Article  Google Scholar 

  110. Shin YS, Han SB. Periprosthetic fracture around a stable femoral stem treated with locking plate osteosynthesis: distal femoral locking plate alone versus with cerclage cable. Eur J Orthop Surg Traumatol. 2017;27(5):623–30.

    PubMed  Article  Google Scholar 

  111. Won H, Kim JY, Baek SH, Hong W, Yoon JW, Kim SY. Feasibility of the inner-side-out use of the LC-DCP for periprosthetic femoral fracture in total hip arthroplasty. Indian J Orthop. 2020;54(6):879–84.

    PubMed  PubMed Central  Article  Google Scholar 

  112. Yoo JI, Parvizi J, Song JU, Ha YC, Lee YK, Koo KH. Trochantoplasty for Total Hip Arthroplasty in Patients With Coxa Vara Deformity. J Arthroplasty. 2017;32(7):2199-203.

  113. Lizaur-Utrilla A, Gonzalez-Parreño S, Miralles-Muñoz FA, Lopez-Prats FA. Cementless, fluted, long-stem hemiarthroplasty for vancouver B2 and B3 periprosthetic fractures around hip hemiarthroplasty. J Arthroplasty. 2019;34(6):1179–83.

    PubMed  Article  Google Scholar 

  114. Moreta J, Uriarte I, Ormaza A, Mosquera J, Iza K, Aguirre U, et al. Martínez-De Los Mozos JL: Outcomes of Vancouver B2 and B3 periprosthetic femoral fractures after total hip arthroplasty in elderly patients. Hip Int. 2019;29(2):184–90.

    PubMed  Article  Google Scholar 

  115. Peiró JVA, Ruiz MJ, Hernández JT, Serra JT, Marsá JS, Vázquez JAP, et al. The inverted Vancouver C fracture. Case series of unstable proximal femur fractures above a knee revision stem treated by short cephalomedullary nail and lateral submuscular overlapping plate. Eur J Orthop Surg Traumatol. 2020.

  116. Valle Cruz JA, Urda AL, Serrano L, Rodriguez-Gonzalez FA, Otero J, Moro E, et al. Incidence of and risk factors for femoral fractures in the gap between hip and knee implants. Int Orthop. 2016;40(8):1697–702.

    PubMed  Article  Google Scholar 

  117. Chatziagorou G, Lindahl H, Karrholm J. Surgical treatment of Vancouver type B periprosthetic femoral fractures: patient characteristics and outcomes of 1381 fractures treated in Sweden between 2001 and 2011. Bone Joint J. 2019;101-B(11):1447-58.

  118. Chatziagorou G, Lindahl H, Garellick G, Kärrholm J. Incidence and demographics of 1751 surgically treated periprosthetic femoral fractures around a primary hip prosthesis. Hip Int. 2019;29(3):282–8.

    PubMed  Article  Google Scholar 

  119. Chatziagorou G, Lindahl H, Kärrholm J. The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems. Acta Orthop. 2019;90(2):135–42.

    PubMed  PubMed Central  Article  Google Scholar 

  120. Chatziagorou G, Lindahl H, Kärrholm J. Lower reoperation rate with locking plates compared with conventional plates in Vancouver type C periprosthetic femoral fractures: A register study of 639 cases in Sweden. Injury. 2019;50(12):2292–300.

    PubMed  Article  Google Scholar 

  121. Mellner C, Mohammed J, Larsson M, Esberg S, Szymanski M, Hellström N, et al. Increased risk for postoperative periprosthetic fracture in hip fracture patients with the Exeter stem than the anatomic SP2 Lubinus stem. Eur J Trauma Emerg Surg. 2019.

  122. Mukka S, Mellner C, Knutsson B, Sayed-Noor A, Sköldenberg O. Substantially higher prevalence of postoperative peri-prosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem. Acta Orthop. 2016;87(3):257–61.

    PubMed  PubMed Central  Article  Google Scholar 

  123. Baum C, Leimbacher M, Kriechling P, Platz A, Cadosch D. Treatment of Periprosthetic Femoral Fractures Vancouver Type B2: Revision Arthroplasty Versus Open Reduction and Internal Fixation With Locking Compression Plate. Geriatr Orthop Surg Rehabil. 2019;10:2151459319876859.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  124. Kabelitz M, Fritz Y, Grueninger P, Meier C, Fries P, Dietrich M. Cementless Stem for Femoral Neck Fractures in a Patient's 10th Decade of Life: High Rate of Periprosthetic Fractures. Geriatr Orthop Surg Rehabil. 2018;9:2151459318765381.

    PubMed  PubMed Central  Article  Google Scholar 

  125. Kraus MJ, Nowakowski AM. Cerclage Breakage in Trochanteric Revision - High Risk for Hip Endoprosthesis? Acta Chir Orthop Traumatol Cech. 2017;84(2):138–40.

    CAS  PubMed  Google Scholar 

  126. Ladurner A, Zurmuhle P, Zdravkovic V, Grob K. Modified Extended Trochanteric Osteotomy for the Treatment of Vancouver B2/B3 Periprosthetic Fractures of the Femur. J Arthroplasty. 2017;32(8):2487-95.

  127. Lenz M, Stoffel K, Gueorguiev B, Klos K, Kielstein H, Hofmann GO. Enhancing fixation strength in periprosthetic femur fractures by orthogonal plating-A biomechanical study. J Orthop Res. 2016;34(4):591–6.

    PubMed  Article  Google Scholar 

  128. Lenz M, Stoffel K, Kielstein H, Mayo K, Hofmann GO, Gueorguiev B. Plate fixation in periprosthetic femur fractures Vancouver type B1-Trochanteric hook plate or subtrochanterical bicortical locking? Injury. 2016;47(12):2800–4.

    PubMed  Article  Google Scholar 

  129. Lenz M, Hofmann-Fliri L, Kasper LA, Varga P, Zderic I, Gehweiler D, et al. Biomechanical evaluation of retrograde docking nailing to a total hip arthroplasty stem in a periprosthetic femur fracture model. Injury. 2020.

  130. Tsai SW, Chen CF, Wu PK, Chen CM, Chen WM. Cement augmentation in the proximal femur to prevent stem subsidence in revision hip arthroplasty with Paprosky type II/IIIa defects. J Chin Med Assoc. 2018;81(6):571–6.

    PubMed  Article  Google Scholar 

  131. Yang TC, Tzeng YH, Wang CS, Lin CC, Chang MC, Chiang CC. Are proximal screws necessary for osteosynthesis of stable-stem periprosthetic femoral fractures fixed with non-locking plate and cable? Injury. 2019;50(10):1739–44.

    PubMed  Article  Google Scholar 

  132. Sariyilmaz K, Korkmaz M, Ozkunt O, Gemalmaz HC, Sungur M, Baydogan M, Kaya I, Dikici F. Comparison of fixation techniques in Vancouver type AG periprosthetic femoral fracture: a biomechanical study. Acta Orthop Traumatol Turc. 2016;50(3):373-8.

  133. Aslam-Pervez N, Riaz O, Gopal S, Hossain F. Predictors of intraoperative fractures during hemiarthroplasty for the treatment of fragility hip fractures. Clin Orthop Surg. 2018;10(1):14–9.

    PubMed  PubMed Central  Article  Google Scholar 

  134. Chakrabarti D, Thokur N, Ajnin S. Cable plate fixation for Vancouver Type-B1 periprosthetic femoral fractures-Our experience and identification of a subset at risk of non-union. Injury. 2019;50(12):2301–5.

    PubMed  Article  Google Scholar 

  135. El-Bakoury A, Hosny H, Williams M, Keenan J, Yarlagadda R. Management of Vancouver B2 and B3 Periprosthetic Proximal Femoral Fractures by Distal Locking Femoral Stem (Cannulok) in Patients 75 Years and Older. J Arthroplasty. 2017;32(2):541–5.

    PubMed  Article  Google Scholar 

  136. Finlayson G, Tucker A, Black ND, McDonald S, Molloy M, Wilson D. Outcomes and predictors of mortality following periprosthethic proximal femoral fractures. Injury. 2019;50(2):438–43.

    PubMed  Article  Google Scholar 

  137. Goudie ST, Patil S, Patton JT, Keating JF. Outcomes following osteosynthesis of periprosthetic hip fractures around cemented tapered polished stems. Injury. 2017;48(10):2194–200.

    CAS  PubMed  Article  Google Scholar 

  138. Johnson AJ, Desai S, Zhang C, Koh K, Zhang LQ, Costales T, et al. A Calcar Collar Is Protective Against Early Torsional/Spiral Periprosthetic Femoral Fracture: A Paired Cadaveric Biomechanical Analysis. J Bone Joint Surg Am. 2020;102(16):1427–33.

    PubMed  Article  Google Scholar 

  139. Jones AR, Williams T, Paringe V, White SP. The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study. Injury. 2016;47(2):428–31.

    PubMed  Article  Google Scholar 

  140. Moazen M, Leonidou A, Pagkalos J, Marghoub A, Fagan MJ, Tsiridis E. Application of Far Cortical Locking Technology in Periprosthetic Femoral Fracture Fixation: A Biomechanical Study. J Arthroplasty. 2016;31(8):1849-56.

  141. Abdel MP, Houdek MT, Watts CD, Lewallen DG, Berry DJ. Epidemiology of periprosthetic femoral fractures in 5417 revision total hip arthroplasties: a 40-year experience. Bone Joint J. 2016;98-b(4):468–74.

    CAS  PubMed  Article  Google Scholar 

  142. Birch CE, Blankstein M, Chlebeck JD, Bartlett Rd CS. Orthogonal plating of Vancouver B1 and C-type periprosthetic femur fracture nonunions. Hip Int. 2017;27(6):578–83.

    PubMed  Article  Google Scholar 

  143. Butler BA, Harold RE, Williams J. Prosthesis-Engaging Retrograde Femoral Nail with Locking Plate for the Treatment of a Vancouver B1 Periprosthetic Femur Fracture Nonunion: A Case Report. JBJS Case Connect. 2019;9(4):e0108.

    PubMed  Article  Google Scholar 

  144. Chalmers BP, Tibbo ME, Trousdale RT, Lewallen DG, Berry DJ, Abdel MP. Primary total hip arthroplasty for charcot arthropathy is associated with high complications but improved clinical outcomes. J Arthroplasty. 2018;33(9):2912–8.

    PubMed  Article  Google Scholar 

  145. Christensen KS, Wicker DI, Wight CM, Christensen CP. Prevalence of postoperative periprosthetic femur fractures between two different femoral component designs used in direct anterior total hip arthroplasty. J Arthroplasty. 2019;34(12):3074–9.

    PubMed  Article  Google Scholar 

  146. Drew JM, Griffin WL, Odum SM, Van Doren B, Weston BT, Stryker LS. Survivorship after periprosthetic femur fracture: factors affecting outcome. J Arthroplasty. 2016;31(6):1283–8.

    PubMed  Article  Google Scholar 

  147. Gitajn IL, Heng M, Weaver MJ, Casemyr N, May C, Vrahas MS, et al. Mortality following surgical management of vancouver B periprosthetic fractures. J Orthop Trauma. 2017;31(1):9–14.

    PubMed  Article  Google Scholar 

  148. Griffiths SZ, Post ZD, Buxbaum EJ, Paziuk TM, Orozco FR, Ong AC, et al. Predictors of perioperative vancouver B periprosthetic femoral fractures associated with the direct anterior approach to total hip arthroplasty. J Arthroplasty. 2020;35(5):1407–11.

    PubMed  Article  Google Scholar 

  149. Khan S, Kyle R. Vancouver B3 fractures: treatment options and tips. J Orthop Trauma. 2019;33(Suppl 6):S14–s17.

    PubMed  Article  Google Scholar 

  150. Lee S, Kagan R, Wang L, Doung YC. Reliability and validity of the vancouver classification in periprosthetic fractures around cementless femoral stems. J Arthroplasty. 2019;34(7S):S277–81.

    PubMed  Article  Google Scholar 

  151. Marshall RA, Weaver MJ, Sodickson A, Khurana B. Periprosthetic femoral fractures in the emergency department: what the orthopedic surgeon wants to know. Radiographics. 2017;37(4):1202–17.

    PubMed  Article  Google Scholar 

  152. RS OC, Owen JR, Hansen EJ, Bashir AS, Wayne JS, Satpathy J, et al. Biomechanical evaluation of osteoporotic proximal periprosthetic femur fractures with proximal bicortical fixation and allograft struts. J Orthop Trauma. 2018;32(10):508–14.

    Article  Google Scholar 

  153. Otero JE, Martin JR, Rowe TM, Odum SM, Mason JB. Radiographic and clinical outcomes of modular tapered fluted stems for femoral revision for paprosky III and IV femoral defects or vancouver B2 and B3 femoral fractures. J Arthroplasty. 2020;35(4):1069–73.

    PubMed  Article  Google Scholar 

  154. Parry JA, Hernandez NM, Berry DJ, Abdel MP, Yuan BJ. Risk factors for subsidence of modular fluted tapered stems used during revision total hip arthroplasty for periprosthetic hip fractures. J Arthroplasty. 2018;33(9):2967–70.

    PubMed  Article  Google Scholar 

  155. Rodriguez JA, Berliner ZP, Williams CA, Robinson J, Hepinstall MS, Cooper HJ. Management of vancouver type-B2 and B3 periprosthetic femoral fractures: restoring femoral length via preoperative planning and surgical execution using a cementless, tapered, fluted stem. JBJS Essent Surg Tech. 2017;7(3):e27.

    PubMed  PubMed Central  Article  Google Scholar 

  156. Scott T, Salvatore A, Woo P, Lee YY, Salvati EA. Gonzalez della valle a: polished, collarless, tapered, cemented stems for primary hip arthroplasty may exhibit high rate of periprosthetic fracture at short-term follow-up. J Arthroplasty. 2018;33(4):1120–5.

    PubMed  Article  Google Scholar 

  157. Tibbo ME, Wyles CC, Fu S, Sohn S, Lewallen DG, Berry DJ, et al. Use of natural language processing tools to identify and classify periprosthetic femur fractures. J Arthroplasty. 2019;34(10):2216–9.

    PubMed  PubMed Central  Article  Google Scholar 

  158. ACt W, Owen JR, Wayne JS, Hess SR, Golladay GJ, Jiranek WA. The effect of prophylactic cerclage wires in primary total hip arthroplasty: a biomechanical study. J Arthroplasty. 2017;32(6):2023–7.

    Article  Google Scholar 

  159. Everding J, Schliemann B, Raschke MJ. Periprosthetic fractures: basics, classification and treatment principles. Chirurg. 2020;91(10):794–803.

    CAS  PubMed  Article  Google Scholar 

  160. Mallory TH, Kraus TJ, Vaughn BK. Intraoperative femoral fractures associated with cementless total hip arthroplasty. Orthopedics. 1989;12(2):231–9.

    CAS  PubMed  Article  Google Scholar 

  161. Capello WN, D'Antonio JA, Naughton M. Periprosthetic fractures around a cementless hydroxyapatite-coated implant: a new fracture pattern is described. Clin Orthop Relat Res. 2014;472(2):604–10.

    PubMed  Article  Google Scholar 

  162. Van Houwelingen AP, Duncan CP. The pseudo A (LT) periprosthetic fracture: it's really a B2. Orthopedics. 2011;34(9):e479–81.

    PubMed  Google Scholar 

  163. Naqvi GA, Baig SA, Awan N. Interobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty. J Arthroplasty. 2012;27(6):1047–50.

    PubMed  Article  Google Scholar 

  164. Rayan F, Dodd M, Haddad FS. European validation of the Vancouver classification of periprosthetic proximal femoral fractures. J Bone Joint Surg Br. 2008;90(12):1576–9.

    CAS  PubMed  Article  Google Scholar 

  165. Corten K, Vanrykel F, Bellemans J, Frederix PR, Simon JP, Broos PL. An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component. J Bone Joint Surg Br. 2009;91(11):1424–30.

    CAS  PubMed  Article  Google Scholar 

  166. Lindahl H, Malchau H, Odén A, Garellick G. Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br. 2006;88(1):26–30.

    CAS  PubMed  Article  Google Scholar 

  167. Dehghan N, McKee MD, Nauth A, Ristevski B, Schemitsch EH. Surgical fixation of Vancouver type B1 periprosthetic femur fractures: a systematic review. J Orthop Trauma. 2014;28(12):721–7.

    PubMed  Article  Google Scholar 

  168. Quah C, Porteous M, Stephen A. Principles of managing Vancouver type B periprosthetic fractures around cemented polished tapered femoral stems. Eur J Orthop Surg Traumatol. 2017;27(4):477–82.

    PubMed  Article  Google Scholar 

Download references

Acknowledgements

Supported by Johannes Kepler Open Access Publishing Fund.

Funding

No funding was obtained for the conduct of this study.

Author information

Authors and Affiliations

  1. Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria

    Clemens Schopper, Matthias Luger, Günter Hipmair, Bernhard Schauer, Tobias Gotterbarm & Antonio Klasan

Authors
  1. Clemens Schopper
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthias Luger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Günter Hipmair
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bernhard Schauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tobias Gotterbarm
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Klasan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

C. Schopper: Wrote the manuscript, performed the statistical analysis, designed the study, acquisition of data, interpretation of the data. M. Luger: Co-wrote the manuscript, acquisition of data, interpretation of the data. G. Hipmair: Revised the manuscript, interpretation of the data. T. Gotterbarm: Revised the manuscript. A. Klasan: Jointly conceived the study, performed statistical analysis, edited the manuscript, interpretation of the data. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Matthias Luger.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

Clemens Schopper: No conflict of interest/no competing interest.

Matthias Luger: No conflict of interest/no competing interest.

Günter Hipmair: Consultant honoraria of ZimmerBiomet, Europe, outside the submitted work.

Bernhard Schauer: No conflict of interest/no competing interest.

Tobias Gotterbarm: Personal fees paid during the conduct of the study from Zimmer Biomet, Europe and from Depuy Synthes Orthopädie Gmbh, Peter Brehm GmbH, ImplanTec GmbH outside the submitted work.

Antonio Klasan: No financial conflict of interest; Associated editor of the BMC Musculoskeletal Disorders journal.

Additionally, we report research grants paid to our institution during the conduct of the study from Zimmer Biomet, Europe, Mathys AG Switzerland, Anika Therapeutics outside the submitted work.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schopper, C., Luger, M., Hipmair, G. et al. The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) - a systematic review. BMC Musculoskelet Disord 23, 280 (2022). https://doi.org/10.1186/s12891-022-05240-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12891-022-05240-w

Keywords

  • Vancouver classification
  • UCS
  • Unified Classification System
  • Periprosthetic fractures

BMC Musculoskeletal Disorders

ISSN: 1471-2474

Contact us