Osteosynthesis of bilateral Vancouver B2 periprosthetic femoral fracture after a bilateral RM® total hip arthroplasty at 24 and 21-years follow-up: A case report

Abstract

INTRODUCTION: The management of periprosthetic femoral fractures following hip arthroplasty is chal-lenging, and the choice between osteosynthesis of the fracture and the revision of the prosthesis is stillmatter of discussion.CASE REPORT: In a 81-year-old male patient, a bilateral Vancouver type-B2 periprosthetic femoral fracturewith stem loosening occurred after an accidental fall. The patient had severe medical comorbidities. Theradiographic study showed a bilateral Robert Mathys cementless total hip arthroplasty at 24 and 21-yearsfollow-up. The fractures were treated with open reduction and fixation with locking compression plates.Bicortical fixation of the loose stem was obtained by the screws of the locking plate, due to the polymericcomposition of the isoelastic femoral stem. Both fractures sites were augmented with bone allografts. Atfollow-up period of 12 months, the X-rays showed bone union of both fractures and bilateral stable stemfixation. The patient expressed high degree of satisfaction with surgery result.DISCUSSION: The standard treatment for Vancouver type-B2 periprosthetic femoral fractures is theremoval of the loose implant, fixation of the fracture, and implantation of a new revision femoral stem.However, the implantation of two long revision hip prostheses is a major operation for an older patientwith precarious health condition, which can contribute to higher risk of medical and prosthetic compli-cations.CONCLUSION: In older patients with multiple comorbidities, the use of locking plates can be a valid treat-ment of bilateral Vancouver B2-periprosthetic femoral fractures following RM®cementless isoelasticstem, as an alternative surgical option to femoral stem revision.