Vancouver B3 Fractures: Treatment Options and Tips

The incidence of periprosthetic fracture around hip arthroplasty has increased with the rise of total hip arthroplasty. These fractures are challenging to treat and often require revision of the femoral prosthesis. Vancouver B3 fractures are particularly difficult to treat because of extensive bone loss and limited options. A revised stable femoral component requires distal femoral fixation. Most cases can be performed with a tapered component or a long-stem fully coated prosthesis. Femoral allograft composite and proximal femoral replacement has been recommended for Vancouver B3 fractures with extremely poor bone stock but is rarely performed today. We present our surgical technique, as well as pearls and pitfalls in treating Vancouver B3 fractures with a loose prosthesis and proximal bone loss.