• Joshua A Parry, Nicolas M Hernandez, Daniel J Berry, Matthew P Abdel, and Brandon J Yuan.
• Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
• J Arthroplasty. 2018 Sep 1; 33 (9): 2967-2970.

BackgroundThe objective of this study was to review Vancouver B2 and B3 periprosthetic hip fractures treated with uncemented modular fluted tapered stems to analyze survivorship, risk factors for stem subsidence, and clinical outcomes.MethodsWe identified 61 Vancouver B2 and B3 periprosthetic hip fractures treated with modular fluted tapered implants. Survivorship, radiographic outcomes, and clinical outcomes were assessed. The mean age at the time of surgery was 72 years, mean body mass index was 30, and mean follow-up was 4.5 years (range, 2-10 years).ResultsSurvivorship free of reoperation or implant revision at 5 years was 89% and 93%, respectively. Eight (13%) stems subsided a mean distance of 18 ± 8 mm (range, 8-28 mm). Stem subsidence was not correlated with age, gender, Vancouver fracture classification, stem bypass, stem length, or stem diameter. Subsidence was correlated with Dorr C type femora (50% vs 7%, 95% confidence interval 9%-72%; P = .007) and strut grafting (50% vs 9%, 95% confidence interval 6%-70%; P = .01). All cases of subsidence stabilized without revision. Subsidence was not correlated with nonunion, reoperation, revision, or a clinical outcome.ConclusionsModular fluted tapered stems had excellent survivorship free of reoperation and implant revision when used for the treatment of Vancouver B2 and B3 periprosthetic femur fractures. Poor bone morphology and the use of strut grafts, both proxies for compromised bone stock and distal fracture patterns, were correlated with stem subsidence. All subsided stems stabilized, and noted subsidence did not portend a worse clinical outcome.Level Of EvidenceLevel III, retrospective cohort.Copyright © 2018 Elsevier Inc. All rights reserved.

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