Fixation versus revision arthroplasty for Unified Classification System type B periprosthetic fractures around cemented polished tapered femoral components

Listen to Amy and Simon discuss the paper 'Fixation versus revision arthroplasty for Unified Classification System type B periprosthetic fractures around cemented polished tapered femoral components' published in the August 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we'll be discussing the paper, 'Fixation versus revision arthroplasty for Unified Classification System type B periprosthetic fractures around cemented polished tapered femoral components: a systematic review and meta-analysis' published in August 2025 by S Walters and colleagues. I'm Amy and I'm here with my co-host Simon.

Hello, Amy. I'm keen to discuss this topic. Periprosthetic femoral fractures or PFFs around hip arthroplasty implants are becoming more common, especially among the elderly.

This study compares two surgical treatment options for managing UCS type B fractures around polished taper-slip (PTS) cemented femoral components, open reduction and internal fixation, or ORIF and revision arthroplasty.

Yes, and it's quite interesting as there's limited comparative data between these two methods. The researchers carried out a systematic review and [00:01:00] meta-analysis to shed some light on this topic.

Precisely. They screened over 4,640 unique results and included four comparative studies in their final analysis covering a total of 539 patients.

Of those, 339 patients were treated with ORIF and 200 with revision arthroplasty. One of the key findings was that ORIF was associated with a clinically significant, though statistically non-significant benefit in terms of reoperation risk. The risk ratio reported was 0.444 translate into an absolute risk reduction of 9.15%.

However, there was an indication of increased mortality in the ORIF group at both 90 days and one year. The ORIF patients were generally older and more frail, possibly accounting for the higher mortality rates.

True but on the positive side, ORIF was significantly associated with a reduction in blood transfusion requirements and shorter hospital stays. The reduction in blood transfusions had a risk ratio of 0.65 [00:02:00] with an absolute risk reduction of 14.07%. The average length of stay was reduced by about 2.45 days.

That's noteworthy, highlighting the less invasive nature of ORIF but let's discuss why these fractures are so tricky to manage. PTS components are designed to mitigate aseptic loosening, but come with a higher risk of periprosthetic fractures due to their ‘axe splitter’ effect when a fall occurs.

Exactly, Amy. The wedge effect of the femoral component within the cement mantle can lead to complex fracture patterns, making the surgical decision more challenging.

And then there's the debate about whether to perform fixation alone or revise the femoral component. Some argue that revision might be necessary since the femoral component is often loose. Others believe that fixation can be effective if the fracture and cement mantle are properly reduced.

Indeed, and this study provided critical insights while also underscoring the need for further research. The complexity of these fractures and the surgical decision-making process highlight the importance of [00:03:00] individualized treatment plans.

As a takeaway, this paper emphasizes the potential advantages of the less invasive ORIF option, especially considering the reduced morbidity associated with it. However, given the non-significant indications of increased mortality, more definitive studies are essential.

Right, and as we conclude, it's vital to reiterate that while ORIF might offer benefits in appropriate cases, the decision should always be carefully tailored to the patient's overall health and the specifics of the fracture.

Well said Simon. This study certainly provides the highest level of evidence available to date on this topic and sets the stage for future research. Thank you for joining me today on AI Talks with Bone & Joint, and thank you to our listeners for tuning in.

Thank you, Amy. Goodbye everyone.