Abstract
BACKGROUND: Periprosthetic femoral fractures (PFFs) following bipolar hemiarthroplasty (BHA) are a serious complication in frail elderly patients. Revision arthroplasty is generally recommended for Vancouver B2 fractures with stem loosening, but it is associated with high perioperative risks. Open reduction and internal fixation (ORIF) has emerged as a less invasive alternative, but its efficacy remains controversial. This multicenter study compared the clinical outcomes of ORIF and revision arthroplasty for Vancouver B2 PFFs after BHA. METHODS: We retrospectively reviewed data from the Trauma Research Group (TRON) registry, encompassing 16 tertiary trauma centers in Central Japan. Between 2010 and 2023, 59 patients with Vancouver B2 fractures following BHA for femoral neck fractures were included: 23 underwent ORIF and 36 received revision arthroplasty. Baseline characteristics, perioperative parameters, postoperative complications, reoperation rates, stem subsidence, RUST score, mortality, and functional outcomes were compared between groups. Functional recovery was evaluated using the Parker Mobility Score (PMS) and the Merle d'Aubigné score. Survival was analyzed using Kaplan-Meier estimates and compared with the log-rank test. RESULTS: The mean age was 81 years, and baseline demographics were similar between groups. Mean operative time and intraoperative blood loss were significantly lower in the ORIF group than in the revision group (153 vs. 207 min, p = 0.021; 340 vs. 752 mL, p = 0.004). No significant differences were found in postoperative complications, reoperation rates (ORIF 13%, revision 8%; p = 0.669), or one-year mortality (approximately 30% in both groups, log-rank p = 0.79). Functional and radiographic outcomes were also comparable between groups. CONCLUSION: For Vancouver B2 PFFs after BHA, ORIF was associated with outcomes comparable to revision arthroplasty while significantly reducing operative time and blood loss. ORIF may be an alternative option in selected high-risk patients, and treatment decisions should be individualized.