ORIGINAL ARTICLE Modular revision stems: how can they help us in the management of Vancouver B2 and B3 periprosthetic fractures? Fernando Marqués & Daniel Perez-Prieto & Raquel Marí & Alfonso Leon & Carlos Mestre & Juan Carlos Monllau Received: 1 May 2014 /Accepted: 16 July 2014 /Published online: 25 July 2014 # EFORT 2014 Abstract Background Over recent years, revision stems have been introduced for the treatment of periprosthetic fractures. Mod- ular stems are supposed to provide some advantages to the surgical treatment of this complication. Purpose To evaluate the midterm radiological and functional results of periprosthetic hip fractures treated with modular revision stems. Methods A retrospective review of 21 patients with a mean age of 77 years (47–88) is here presented. They had suffered a periprosthetic femoral fracture around a total hip arthroplasty between 2004 and 2010. Sixteen of them were a Vancouver classification type B2 and 5 were type B3. In all cases, a transfemoral approach was performed. Previous stems were exchanged for Revitan® (Zimmer) modular stems. There were 14 curved stems and 7 straight stems. The mean patient follow-up period was 22 months. Functional results were assessed using the Merle d’Aubigné score. The degree of subsidence was determined by comparing the postoperative images with those taken during the very last follow-up. Results No stem loosening was observed during follow-up. There was one non-union of the femoral osteotomy which was not of either clinical or functional relevance. Subsidence was less than 4 mm in 19 cases; one case showed 7 mm of subsidence and the other had 21 mm at final follow-up. Three patients (14 %) had to be operated on again. One of them was due to a refracture, another for acetabular loosening and one more due to reiterative dislocation (an additional case of dislocation was conservatively treated). The mean Merle d’Aubigné score at final follow-up was 5-5-4. Mortality stood at 19 % throughout follow-up. Conclusions Modular revision stems provide some advan- tages compared with osteosynthesis in that they make early weight bearing possible. In addition, version, offset, and limb length is easier to control and calculate. Therefore, modular revision stems should be considered the treatment of choice for periprosthetic femoral fractures. Keywords Arthroplasty . Periprosthetic fractures . Grafting Introduction Fractures around the femoral component of a total hip arthroplasty become more common as a patient’ s age in- creases [1]. In fact, these fractures remain a common cause for reoperation following total hip replacement (THR) and account for 5 to 10 % of revisions worldwide [2]. The Van- couver classification (introduced by Duncan [3]) is of thera- peutic value as an exchange of the stem is necessary when the prosthesis loosens (Vancouver B2 and B3 fractures). Several authors [4–6] have reported good outcomes with the use of modular, tapered, and fluted uncemented titanium stems with distal fixation for the treatment of this complex condition. This stems are thought to provide easier control of the version, offset, and limb length when compared to the plate synthesis technique [4–6]. Although it is difficult to achieve anatomical reduction of the fracture with them, it is not the primary goal with these fractures as they are not intra-articular fractures. The purpose of this study is to present the clinical and radiological outcomes of Vancouver B2 and B3 periprosthetic fractures surgically treated with the Revitan system as well as to review the results published in the literature to date (Fig.1). D. Perez-Prieto : R. Marí : A. Leon : C. Mestre : J. C. Monllau Consorci Parc de Salut Mar (Hospital de l’Esperança), Universitat Autònoma de Barcelona, Barcelona, Spain F. Marqués (*) Department of Orthopaedic Surgery and Traumatology, Hospital de l’Esperança – Parc de Salud MAR, Sant Josep de la Muntanya, Barcelona, SPAIN e-mail: fmarques@parcdesalutmar.cat Eur Orthop Traumatol (2015) 6:23–26 DOI 10.1007/s12570-014-0269-8