Current Practice of Italian Association of Revision Surgery Members in the Treatment of Unified Classification System Type B Periprosthetic Femoral Fracture Around Hip Arthroplasty: A Cross-Sectional Survey

Abstract

Introduction: Periprosthetic femoral fracture around hip arthroplasty are growing in the world, nevertheless management and treatment options for fractures “around the stem” are still debated due to lack of high-level studies. Materials and method: A 85-item survey were fill out by 40 Italian Orthopedic Surgeon member of SIOT (Società Italiana di Ortopedia e Traumatologia) and AIR (Associazione Italiana Riprotesizzazione) to assess their current opinion in the management of type B periprosthetic femoral fractures. Responses were summarized using proportions, and further stratified by practice type, case volume, surgeon age, and fellowship training. Results: Vancouver/UCS fracture classification showed a good interobserver agreement (k value =.76). ORIF were the treatment of choice for UCS type B1 fractures (100%), revision stem for B2 (85%) and B3 (100%). Locked plates were preferred to cable plate and cerclage without a plate for B1 fractures (50% vs 40% vs 10%); revision with modular stem was preferred to monoblock stem for B2 fractures (50% vs 35%) and B3 (75% vs 15%). Responders tended to postpone at 1-month weight-bearing in patients with B1 fractures. Regarding postoperative pharmacological treatment there was absolute lack of consensus. Discussion: The primary finding of our survey confirmed the preference of ORIF for B1 fractures and stem revision for B2 and B3 fractures. However, there is no definitive operative technique for all UCS B fractures. Surgeons tended to favor locked plating over cable plating, although only slightly. This general lack of consensus coincides with the inconclusive evidence that currently exists in the literature, which demonstrates both favorable and unfavorable outcomes for both techniques Conclusions: The absence of complete homogeneity among participants showed the need for prospective randomized studies to set up stronger guidelines for classification, management, surgical treatment, rehabilitation, and pharmacological support of periprosthetic femoral fractures.