A 72-year-old man with a cemented total knee replacement 8 years ago develops a Vancouver type B2 periprosthetic femoral fracture. The implant is found to be loose on imaging. What is the most appropriate management?
- A Revision total knee arthroplasty using a long-stem revision femoral component with fracture fixation ✓
- B Open reduction and internal fixation with a locking plate
- C Revision total hip arthroplasty with a long-stem femoral implant bypassing the fracture
- D Conservative management with traction followed by early mobilisation
Correct answer: A. Revision total knee arthroplasty using a long-stem revision femoral component with fracture fixation
Explanation
Vancouver B2 periprosthetic fractures involve a loose femoral component, making ORIF alone inadequate since the underlying instability would persist. The standard of care is revision arthroplasty using a long-stem revision femoral component that bypasses the fracture by at least two cortical diameters, re-establishing fixation. A long-stem THR revision would apply to hip periprosthetic fractures, not knee. Conservative management is inappropriate given the loose implant.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.