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

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Reese Marlowe in Health & Wellness April 2025 • 4 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.

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