Mortality and Clinical Outcomes of 173 Vancouver Type B Periprosthetic Femoral Fractures: A Single-Centre Study With Minimum Two-Year Follow-Up

Key Words: Periprosthetic Femoral Fracture; Mortality; Open Reduction and Internal Fixation; Revision Total Hip Arthroplasty Objective Periprosthetic Femoral Fracture (PFF) is a serious complication following hip arthroplasty, associated with high mortality and complication rates. Vancouver Type B fractures account for the majority of PFFs and are the most challenging to manage. This study aimed 1) to identify risk factors for one-year mortality after Vancouver Type B PFFs; and 2) to report mid-to-long term clinical outcomes among PFF subtypes treated with either internal fixation or revision arthroplasty. Methods We conducted a retrospective review of patients diagnosed with PFF at our institution between January 2010 and June 2023. Through data review and clinical follow-up, we collected patient demographics, preoperative comorbidities, postoperative complications, survival status, Parker Mobility Score (PMS), and Harris Hip Score (HHS) at the most recent follow-up. Logistic regression was used to identify risk factors for one-year mortality after fracture occurrence. Among patients with loosened femoral stems (Vancouver Type B2 and B3), we compared clinical outcomes between patients treated with open reduction and internal fixation (ORIF) and revision arthroplasty. Results A total of 173 patients (104 male, 69 female) were enrolled, with a mean age of 68.1±14.8 years (range, 26–93). The cohort included 81 type B1 fractures (9 treated conservatively, 70 with ORIF, and 2 with revision), 73 type B2 fractures (2 conservative, 16 ORIF, 55 revisions), and 19 type B3 fractures (2 ORIF and 17 revisions). By the most recent follow-up, 46 patients (26.6%) had died, including 10 (5.8%) within one year post-fracture. Risk factors for one-year mortality included cardiovascular comorbidities (OR 7.69, 95% CI: 1.60–37.06, p = 0.011), neurovascular comorbidities (OR 9.12, 95% CI: 1.74–47.89, p = 0.009), and conservative treatment (OR 29.96, 95% CI: 4.83–186.00, p < 0.001). The mean HHS was 78.3 ± 14.7 (range, 23–100), and the mean PMS was 6.4 ± 2.4 (range, 0–9). Although B3 fractures showed the highest scores and B2 the lowest, the differences were not statistically significant. In subgroup analysis of B2/B3 cases treated with ORIF or revision, there were no differences in age or comorbidities; however, the ORIF group had significantly higher complication rates (5/18 vs. 6/72, p = 0.039) and lower HHS (68.9 ± 18.7 vs. 79.6 ± 11.9, p = 0.048). Conclusions Cardiovascular comorbidities, neurovascular comorbidities, and conservative treatment are significant risk factors for one-year mortality following Vancouver Type B PFFs. For B2 and B3 fractures, although ORIF may be successful in selected cases, it is associated with inferior functional outcomes and higher complication rates compared with revision arthroplasty. Future studies are needed to establish a clear treatment algorithm for B2 fractures to reduce failure rates.