Bipolar hemiarthroplasty (BHA) is widely employed as a standard treatment for proximal femoral fractures in elderly patients. With the aging of the global population, the incidence of femoral neck fractures requiring BHA is increasing, leading to a corresponding increase in periprosthetic femoral fracture (PFF) cases [1]. Generally, the treatment of PFFs may be considered more challenging in patients who have undergone BHA than in those who have undergone total hip arthroplasty (THA). This potential for increased difficulty is often attributed to BHA recipients typically being of more advanced age, possessing poorer bone quality, and having a greater burden of comorbidities [2]. Consequently, factors such as existing implants, reduced bone stock, and prevalent osteoporosis in this patient group contribute to the complexity of PFF management.

The Vancouver classification system is commonly utilized for PFF treatment strategies and typically recommends internal fixation for type B1 and C fractures (stable stem) and revision surgery for B2 and B3 fractures (unstable stem or poor bone quality) [3]. This system, however, was primarily derived from experiences with THA patients. Compared with THA recipients, BHA recipients often present with distinct characteristics, including more advanced age, poorer bone quality, and different functional demands; therefore, the optimal and direct applicability of this classification system to PFFs following BHA warrants further elucidation [4]. The limited nature of previous research specifically on PFF following BHA underscores this need for clarity. For example, an investigation of 89 cases reported overall incidence and mortality but did not comprehensively address specific risk factors for mortality, differences in mortality according to fracture type, or the detailed postoperative ambulatory function [5]. PFFs in this vulnerable BHA patient cohort represent severe events that are frequently associated with substantial morbidity given their underlying frailty and compromised bone quality [6,7]. Consequently, how PFF patterns, such as those described by the Vancouver classification, are related to critical outcomes (e.g., mortality) in this specific population remains insufficiently understood, hindering accurate risk assessment and prognostication.

The primary aim of this retrospective multicenter study was to investigate the relationships between Vancouver classification types and key clinical outcomes, specifically one-year mortality and postoperative functional status, in elderly femoral neck fracture patients who sustained a PFF following BHA.