{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T21:54:56Z","timestamp":1790114096913,"version":"4.0.1"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n 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 \u221242.28 minutes, 95% CI \u221271.27 to \u221213.29; 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Therapeutic\n Level III<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.rvw.25.00215","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T19:00:23Z","timestamp":1766775623000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Fixation vs. Revision of Vancouver B2 Periprosthetic Fractures Around Polished Tapered Cemented Femoral Stems"],"prefix":"10.2106","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6710-8602","authenticated-orcid":false,"given":"Zain","family":"Choudhary","sequence":"first","affiliation":[{"name":"University Hospital of North Midlands, Stoke-on-Trent, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9797-2062","authenticated-orcid":false,"given":"Sachin","family":"Singal","sequence":"additional","affiliation":[{"name":"University Hospital of North Midlands, Stoke-on-Trent, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0174-6934","authenticated-orcid":false,"given":"Amr","family":"Selim","sequence":"additional","affiliation":[{"name":"School of Medicine, Keele University, Staffordshire, United Kingdom"},{"name":"Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8936-4202","authenticated-orcid":false,"given":"Abdelrahman","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"University Hospital of North Midlands, Stoke-on-Trent, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5074-867X","authenticated-orcid":false,"given":"Ronald Hang Kin","family":"Nam","sequence":"additional","affiliation":[{"name":"University Hospital of North Midlands, Stoke-on-Trent, United Kingdom"},{"name":"School of Medicine, Keele University, Staffordshire, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9422-7282","authenticated-orcid":false,"given":"Abdul-Basit","family":"Rafi","sequence":"additional","affiliation":[{"name":"University Hospital of North Midlands, Stoke-on-Trent, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6895-460X","authenticated-orcid":false,"given":"Siddharth","family":"Govilkar","sequence":"additional","affiliation":[{"name":"University Hospital of North Midlands, Stoke-on-Trent, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8737-1394","authenticated-orcid":false,"given":"Geraint","family":"Thomas","sequence":"additional","affiliation":[{"name":"School of Medicine, Keele University, Staffordshire, United Kingdom"},{"name":"Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,12]]},"reference":[{"issue":"10","key":"r1-20251226","doi-asserted-by":"crossref","first-page":"e1004462","DOI":"10.1371\/journal.pmed.1004462","article-title":"The incidence of postoperative periprosthetic femoral fracture following total hip replacement: an analysis of UK National Joint Registry and Hospital Episodes statistics data","volume":"21","author":"Lamb","year":"2024","journal-title":"PLoS Med"},{"key":"r2-20251226","first-page":"e23.00135","article-title":"Periprosthetic femoral fractures-beyond B2","volume":"8","author":"Uzoigwe","year":"2024","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"issue":"2","key":"r3-20251226","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.injury.2010.06.003","article-title":"What is the financial cost of treating periprosthetic hip fractures?","volume":"42","author":"Phillips","year":"2011","journal-title":"Injury"},{"issue":"4","key":"r4-20251226","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1177\/2151458514542281","article-title":"Mortality and financial burden of periprosthetic fractures of the femur","volume":"5","author":"Shields","year":"2014","journal-title":"Geriatr Orthop Surg Rehabil"},{"key":"r5-20251226","first-page":"293","article-title":"Fractures of the femur after hip replacement","volume":"44","author":"Duncan","year":"1995","journal-title":"Instr Course Lect"},{"issue":"16","key":"r6-20251226","first-page":"234","article-title":"Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls","volume":"3","author":"Fleischman","year":"2015","journal-title":"Ann Transl Med"},{"issue":"1","key":"r7-20251226","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-0163.R1","article-title":"B2 or not B2? 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