Fixation vs. Revision of Vancouver B2 Periprosthetic Fractures Around Polished Tapered Cemented Femoral Stems
Bibliographic record
Abstract
BACKGROUND: The management of periprosthetic femoral fractures (PFFs) around polished taper-slip (PTS) cemented femoral stems in total hip arthroplasty has seen a recent shift in practice from revision to open reduction and internal fixation (ORIF). While ORIF is the accepted standard for stable uncemented stems, evidence guiding optimal management of PFF around cemented stems remains inconclusive. This metanalysis aimed to compare the outcomes of ORIF vs. revision in patients with Vancouver B2 PFFs around cemented PTS femoral stems. METHODS: We systematically searched MEDLINE, Embase, CENTRAL, Scopus, and ClinicalTrials.gov from inception to May 2025, for studies comparing ORIF with revision arthroplasty in adults with Vancouver type B2 PFFs around cemented PTS stem. None of the included studies were randomized control trials (RCTs). The outcomes were 5-year implant survival, 2-year reoperation rate, 1-year mortality, infection, aseptic loosening, nonunion, and operative time. RESULTS: Eight studies involving 675 patients (318 ORIF, 357 revision) met eligibility criteria. The mean age was 82.2 years, and the mean follow-up was 2.8 years. Two-year reoperation was significantly lower with ORIF (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.14-0.53, p < 0.001). Operative time was significantly shorter in the ORIF group (mean difference -42.28 minutes, 95% CI -71.27 to -13.29; p < 0.001). No significant differences were observed in 5-year implant survival (OR 0.64, 95% CI 0.26-1.60) or 1-year mortality (OR 2.05, 95% CI 0.71-5.89). Postoperative infection, aseptic loosening, and nonunion rates were also similar. Risk of bias was moderate overall. CONCLUSION: For patients with Vancouver B2 PFFs around cemented PTS femoral stems, ORIF was associated with a significantly lower 2-year reoperation rate and shorter operative time compared with revision, while other outcomes were similar. These findings indicate comparable overall performance between ORIF and revision; however, given the heterogeneity and potential selection bias, uncertainty remains high, supporting the need for an RCT to evaluate both options. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.024 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.011 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".