Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Open Reduction and Internal Fixation for Vancouver B1 and B2 Periprosthetic Femoral Fractures: A Proportional Meta-Analysis

  • Byung-Ho Yoon (Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine) ;
  • Seong Gyun Park (Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine) ;
  • Young Hak Roh (Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine)
  • Received : 2023.03.23
  • Accepted : 2023.05.23
  • Published : 2023.12.31
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Abstract

Purpose: Periprosthetic femoral fracture (PFF) is a common complication after total hip arthroplasty, and open reduction and internal fixation (ORIF) is a common surgical treatment. We conducted a meta-analysis to compare the outcomes of ORIF in patients with different fracture patterns (Vancouver B1 and B2). Materials and Methods: We conducted a systematic search of PubMed, Embase, Cochrane Library and KoreaMed from inception to August 2022. We conducted a pair-wise meta-analysis (with a fixed-effects model) on the 10 comparative studies and a proportional meta-analysis on the data from the 39 articles to determine a consensus. The outcomes were the incidence of reoperations that included osteosynthesis, irrigation/debridement and revision arthroplasty. Results: The pair-wise meta-analysis showed similar outcomes between two groups; the risk of reoperation (odds ratio [OR]=0.82, confidence interval [CI] 0.43-1.55, P=0.542), nonunion (OR=0.49; CI 0.22-1.10, P=0.085) and deep infection (OR=1.89, CI 0.48-7.46, P=0.361). In proportion meta-analysis, pooled prevalence of reoperation was 9% (95% CI, 6-12) in B1 and 8% (95% CI, 2-15) in B2 (heterogeneity between two groups (Q), P=0.772). The pooled prevalence of nonunion was same as of 4% in B1 and B2 (Q, P=0.678), and deep infection was 2% (95% CI, 1-3) in B1 and 4% (95% CI, 2-7) in B2 (Q, P=0.130). Conclusion: ORIF is a feasible treatment for B1 and B2 periprosthetic femoral fractures, with acceptable outcomes in terms of, nonunion and infection. The results of this study would help clinicians and provide baseline data for further studies validating PFF.

Keywords

Acknowledgement

This work was supported by the 2021 Hip and Pelvis Research grant funded by the Korean Hip Society.

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