Mosher Zachary A, Strait Alexander V, Olson Nicholas R, Wolfe Jared A, Ho P Henry, Hopper Robert H, Hamilton William G
Anderson Orthopaedic Research Institute, Alexandria, Virginia.
Anderson Orthopaedic Research Institute, Alexandria, Virginia; Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, Virginia.
J Arthroplasty. 2025 Aug;40(8S1):S328-S332. doi: 10.1016/j.arth.2025.03.024. Epub 2025 Mar 17.
Cementless stems have been the predominant type of femoral component used for total hip arthroplasty (THA) in the United States for several decades. However, recent literature has reported an increased periprosthetic fracture (PPFx) rate and complications associated with these components, particularly among older patients. This study evaluated the incidence and outcome of Vancouver B PPFx after primary THA using cementless stems.
A single institution's database was used to identify 12,400 primary THAs performed from 2009 through 2023. The mean age at surgery was 64 years, and 57% of THAs were performed among women. All postoperative PPFx were identified, and those classified as Vancouver B were evaluated for treatment method and secondary reoperations.
Among 72 postoperative PPFx, 34 were classified as Vancouver B for an overall rate of 0.3% (34 of 12,400). The median time from THA to Vancouver B PPFx was 33 days. Patients aged > 75 years at surgery had a higher rate of Vancouver B PPFx (0.6%, 13 of 2,094) compared to patients aged 18 to 75 years at surgery (0.2%, 21 of 10,306, P < 0.001). Type C3 triple-taper collared titanium stems had a lower fracture rate (0.1%, four of 4,748) compared to Type A flat taper stems (0.7%, 23 of 3,105, P < 0.001). In patients over 75 at surgery, Type C3 stems had a lower fracture rate (0.3%, three of 923) compared to Type A stems (1.5%, seven of 472, P = 0.04). There were 28 patients who had Vancouver B fractures (82%) who underwent reoperation. Secondary reoperations were performed among 25% (seven of 28) of THAs, and three of these involved periprosthetic joint infection.
Consistent with other reports, the Vancouver B PPFx rate was higher in patients aged > 75 years at surgery. At our institution, Type C3 triple-taper collared titanium stems lowered the PPFx fracture rate in all age groups, including those over age 75 years at surgery. Secondary reoperations remain highly morbid to patients.
在美国，数十年来非骨水泥型股骨柄一直是全髋关节置换术（THA）中使用的主要股骨组件类型。然而，最近的文献报道了与这些组件相关的假体周围骨折（PPFx）发生率增加及并发症，尤其是在老年患者中。本研究评估了使用非骨水泥型股骨柄进行初次THA后温哥华B型PPFx的发生率及结果。
使用单一机构的数据库识别2009年至2023年期间进行的12400例初次THA。手术时的平均年龄为64岁，57%的THA在女性中进行。识别出所有术后PPFx，并对那些分类为温哥华B型的进行治疗方法和二次再手术评估。
在72例术后PPFx中，34例被分类为温哥华B型，总体发生率为0.3%（12400例中的34例）。从THA到温哥华B型PPFx的中位时间为33天。手术时年龄>75岁的患者温哥华B型PPFx发生率（0.6%，2094例中的13例）高于手术时年龄在18至75岁的患者（0.2%，10306例中的21例，P<0.001）。C3型三锥领钛柄的骨折率（0.1%，4748例中的4例）低于A 型平锥柄（0.7%，3105例中的23例，P<0.001）。在手术时年龄超过75岁的患者中，C3型柄的骨折率（0.3%，923例中的3例）低于A 型柄（1.5%，472例中的7例，P=0.04）。有28例发生温哥华B型骨折的患者（82%）接受了再手术。25%（28例中的7例）的THA进行了二次再手术，其中3例涉及假体周围关节感染。
与其他报告一致，手术时年龄>75岁的患者温哥华B型PPFx发生率更高。在我们机构，C3型三锥领钛柄降低了所有年龄组的PPFx骨折率，包括手术时年龄超过75岁的患者。二次再手术对患者来说仍然具有很高的 morbidity 。
