9. Vancouver classification of postoperative periprosthetic femur fractures around total hip arthroplasty

#### 9.1. Classification

Type A: Peritrochanteric.

AG: Greater trochanter.

AL: Lesser trochanter.

Type B: Around or just distal to the tip of the stem.

B1: Well-fixed femoral component.

B2: Loose femoral component.

B3: Loose femoral component and poor bone stock.

Type C: Well distal to the stem.

#### 9.2. Clinical application

This classification guides the surgeon with treatment decision.

AG and AL: Usually stable and can be treated non-operatively.

B1: ORIF if displaced.

B2: Revision to long stem.

B3: Revision with struct grafting.

C: ORIF.

9. Vancouver classification of postoperative periprosthetic femur fractures

around total hip arthroplasty

Figure 6. Intraoperative Vancouver classification.

B1: Well-fixed femoral component.

B2: Loose femoral component.

Type C: Well distal to the stem.

Type B: Around or just distal to the tip of the stem.

B3: Loose femoral component and poor bone stock.

9.1. Classification

Type A: Peritrochanteric. AG: Greater trochanter. AL: Lesser trochanter.

28 Total Hip Replacement - An Overview

#### 9.3. Reliability

A European validation for this classification was performed by Rayan et al. The study had included consultants, trainees and medical students. It was noted to have an inter observer reliability of substantial agreement among consultants (k value of 0.72–0.74) orthopedic trainees (k value of 0.68–0.70) and medical students (k value of 0.61). The validity within B type fractures revealed an agreement of 77% with a k value of 0.67 [9, 10] (Figure 7).

Figure 7. Postoperative Vancouver classification.
