Incidence of Periprosthetic Femoral Fractures Following Hip Arthroplasty Using Bone Preserving Short Stem: A Multicenter Retrospective Analysis of 1089 Cases

Abstract

In recent years, there has been an increase in hip joint replacement surgery using short bone-preserving femoral stem. However, there are very limited data on postoperative periprosthetic fractures after cementless fixation of these stem although the periprosthetic fracture is becoming a major concern following hip replacement surgery. The purpose of this study is to determine incidence of postoperative periprosthetic femoral fractures following hip arthroplasty using bone preserving short stem in a large multi-center series. Materials & Methods :

We retrospectively reviewed 897 patients (1089 hips) who underwent primary total hip arthroplasty (THA) or bipolar hemiarthroplasty (BHA) during the same interval (2011–2016) in which any other cementless, short bone-preserving femoral stem was used at 7 institutions. During the study, 1008 THAs were performed and 81 BHAs were performed using 4 different short femoral prostheses. Average age was 57.4 years (range, 18 – 97 years) with male ratio of 49.7% (541/1089). Postoperative mean follow-up period was 1.9 years (range, 0.2 – 7.9 years).

Results :

Overall incidence of postoperative periprosthetic femoral fractures was 1.1% (12/1089). The mean age of these 12 patients were 71.2 year (range, 43 – 86 years). Seven patients were female and other 5 were male. Time interval between primary arthroplasty and fracture were mean 1.1 years (range, 0.1 – 4.8 years). Injury mechanism is a slip in 10 fractures and fall from 1m or less in 2. Three fractures occurred after BHA while 9 occurred after THA. Four fractures were in type AG and other 8 were in type B1 according to Vancouver classification. Of the 4 with AG type, 2 underwent open reduction and internal fixation and 2 took conservative management. Of the 8 with B1 type, 6 underwent open reduction and internal fixation and 2 took conservative management.

Conclusion :

The prevalence of postoperative periprosthetic femoral fractures was 1.1% in a multicenter retrospective analysis of 1089 hips. Our findings suggest that postoperative periprosthetic fracture can occur after hip replacement surgery using short bone-preserving stem although the incidence is relatively low.