A comparative study of ORIF and stem revision for Vancouver B2 periprosthetic fractures of the femur in elderly patients

Purpose The aim of this study was to compare stem revision and ORIF for the treatment of Vancouver B2 periprosthetic fractures of the femur. Methods From June 2012 to May 2022, 56 consecutive patients were studied at our institution. Four patients were lost to follow-up, four had incomplete data. Thus, 48 cases were included in the analysis. The patients were divided into a stem revision group (SR, group 1 with 25 patients) and an open reduction and internal fixation group (ORIF, group 2 with 23 patients). The surgical complications, perioperative parameters, and 1-year mortality rates were assessed, the functional outcomes were assessed with the Harris Hip Score, and the radiographic outcomes were assessed in accordance with the Beals and Tower criteria. Results In group 1, the mean follow-up time was 41.2 months, 40% of patients experienced complications, the mean HHS was 75.27, and 92% of the patients had “excellent–good” radiographic outcomes. In group 2, 21.7% of patients experienced complications, the mean HHS was 73.56, and 91.3% of the patients had “excellent–good” radiographic outcomes. The total number of postoperative complications, dislocation rate, blood loss volume, operation time and transfusion rate were lower in group 1 (ORIF), and two patients in group 2 (SR) experienced hip dislocation. There were no significant differences in the 1-year mortality rate, bone healing time or reoperation rate between the two groups. However, the time to total weight-bearing in the SR group was shorter than that in the ORIF group, and the radio subsidence rate in the SR group was lower than that in the ORIF group, especially for patients with poor compliance. The postoperative quality of life of the patients in the two groups was worse than their original quality of life before fracture. Conclusions Stem revision and ORIF are effective treatments for Vancouver B2 fractures. However, ORIF can be an option for elderly patients with several medical disorders, while stem revision is advantageous in terms of earlier weight bearing.