$Surreal image of a fractured hip implant being rebuilt with glowing bone fragments.$

Fracture Fixes: How Revision Surgery Can Get You Back on Your Feet

Reese Marlowe in Health & Wellness August 2025 • 3 min read.

"A look at modern techniques for dealing with fractures around hip implants and restoring mobility."

Hip replacement surgery is increasingly common, leading to a rise in periprosthetic fractures—fractures occurring around the implant. Among these, fractures around the femoral stem (the part of the implant in the thigh bone) pose a significant challenge. These fractures often result from low-energy traumas like falls, making them a concern for older adults.

When these fractures occur and the original implant becomes loose, a revision surgery is often needed. Planning this surgery requires careful consideration, especially regarding the classification of the fracture—the Vancouver classification being a widely used system. This system helps surgeons decide between conservative treatments and more invasive surgical options, like revising the femoral stem.

While research exists on how to manage these fractures, there’s limited data on treating cases with a loose femoral stem. This article will explore the outcomes of revision surgeries that address fractures around the femoral stem, specifically focusing on Vancouver B2 and B3 types, where the stem is loose or significant bone loss is present.

Surgical Solutions: Revision and Bone Grafting

Surreal image of a fractured hip implant being rebuilt with glowing bone fragments.

Researchers conducted a study to evaluate the effectiveness of femoral stem revision for Vancouver B2 and B3 periprosthetic fractures. The study involved 15 patients who underwent surgery for unstable femoral fractures after a prior hip replacement. All patients underwent open reduction and long stem revision, a procedure that involves realigning the bone fragments and replacing the existing stem with a longer one for better stability.

In cases of Vancouver B3 fractures, where bone loss is more severe, surgeons used a combination of open reduction, long stem revision, and allogenic cancellous bone graft. This involves using donor bone to fill in the gaps and promote healing, similar to the approach used in B2 fractures. When extra support was needed, an allogenic onlay cortical bone graft was added.

Here’s what the procedure typically involves:

Assessment: Determining the fracture type and stem stability.
Stem Removal: Removing the old, unstable femoral stem.
Bone Grafting: Filling in bone loss with donor bone.
Revision: Inserting a new, longer femoral stem for enhanced stability.

The study followed patients for an average of 31.5 months, assessing their clinical and radiographic outcomes. The results, using the Beals and Tower’s criteria, indicated mostly fair to good outcomes. Fractures healed in all 15 patients. Some patients experienced minor issues like non-union of the greater trochanter or superficial infections, but no major complications like dislocations or nerve injuries were reported.

A Path to Recovery

This study suggests that for Vancouver B2 and B3 fractures with a loose femoral stem, open reduction and long stem revision with bone grafting can lead to satisfactory results. However, the researchers emphasize the need for long-term follow-up to ensure lasting stability. If you or a loved one is facing a periprosthetic fracture, discuss all treatment options with your orthopedic surgeon to determine the best course of action.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4055/jkoa.2013.48.3.197, Alternate LINK

Title: Femoral Stem Revision For Vancouver Type B2 And B3 Periprosthetic Fractures

Journal: Journal of the Korean Orthopaedic Association

Publisher: The Korean Orthopaedic Association

Authors: Yoon Jae Seong, Won Chul Shin, Hyung Joon Cho, Jung Sub Lee, Kuen Tak Suh

Published: 2013-01-01

Everything You Need To Know

Why are fractures around hip implants, specifically those near the femoral stem, a growing concern?

Periprosthetic fractures, specifically those around the femoral stem after a hip replacement, present a significant challenge, especially in older adults who may experience low-energy traumas like falls. When the original implant becomes loose due to these fractures, a revision surgery is often necessary to restore stability and function. The rise in hip replacement surgeries has led to an increase in these types of fractures, making their management an important area of focus in orthopedic surgery. Limited data exists regarding how to treat these fractures when the femoral stem is loose, making studies like the one referenced essential for improving treatment strategies.

What is the Vancouver classification and how does it guide treatment decisions for fractures around hip implants?

The Vancouver classification is a widely used system for categorizing periprosthetic fractures around the hip implant. It assists surgeons in determining the most appropriate treatment approach, ranging from conservative management to more invasive surgical options like revising the femoral stem. Specifically, Vancouver B2 fractures involve a fracture around a loose stem, while B3 fractures also involve a loose stem but with significant bone loss. Understanding the classification is crucial, as it guides decisions on whether to revise the stem, use bone grafting, or employ other techniques to stabilize the fracture and restore function. Without the Vancouver classification a surgeon might not be able to determine the correct method of surgery or if surgery is even needed.

What surgical techniques are commonly used to address Vancouver B2 and B3 fractures with a loose femoral stem?

In cases of Vancouver B2 and B3 fractures with a loose femoral stem, a surgical approach involving open reduction and long stem revision with bone grafting is often employed. Open reduction involves realigning the bone fragments, while long stem revision entails replacing the existing femoral stem with a longer one to provide enhanced stability. Bone grafting, particularly using allogenic cancellous bone graft (donor bone), is used to fill in areas of bone loss and promote healing. For additional support, an allogenic onlay cortical bone graft may be added. The goal is to achieve fracture healing, restore hip stability, and improve patient outcomes.

How were the outcomes evaluated in the study, and what were the general results of using open reduction and long stem revision with bone grafting?

The study assessed outcomes using the Beals and Tower’s criteria, which generally indicated fair to good results following open reduction and long stem revision with bone grafting for Vancouver B2 and B3 fractures. Fracture healing was achieved in all 15 patients included in the study. While some patients experienced minor issues like non-union of the greater trochanter or superficial infections, no major complications such as dislocations or nerve injuries were reported. These results suggest that the surgical approach can be effective in restoring stability and function, but long-term follow-up is essential to ensure lasting success. The absense of the Beals and Tower's criteria would have made an objective assessment of the patient's outcome impossible.

What are the key considerations for long-term success after undergoing revision surgery for a fracture around a hip implant?

While the study showed promising results for open reduction and long stem revision with bone grafting in treating Vancouver B2 and B3 fractures, the researchers emphasize the importance of long-term follow-up. This is because the long-term stability of the revised hip and the durability of the bone grafts need to be monitored to ensure the best possible outcome for patients. Additional research with larger patient groups and longer follow-up periods could further refine the surgical techniques and improve our understanding of the factors that contribute to lasting stability and function after revision surgery. It would be benifical to see what happens after 5-10 years.