Periprosthetic Fractures of the Femur during the Operation of Primary Total Hip Arthroplasties^[*]

Abstract

Objective To determine the incidence of periprosthetic femoral fractures during the operation in primary hip arthroplasties and correlate them with the inherent risk factors associated with patients, implants, and the diagnosis of coxarthrosis and/or femoral neck fractures.

Methods Cross-sectional study, with retrospective analysis of medical records and image exams of patients operated between 2014 and 2019. The variables analyzed followed those proposed by the world literature, namely: age, sex, Dorr index, surgical indication, Vancouver classification, location, type of fixation (cemented or non-cemented), implant model used, intraoperative diagnosis, and corresponding treatment approach. All surgeries used the same posterolateral access route and were performed by the same group of surgeons.

Results Within the sample of 2,217 arthroplasties (2,154 patients), 12 fractures (0.56%) were identified in 12 patients. The sample consisted of 8 females and 4 males, with an average age of 62.53 years. In all diagnosed cases, protective cerclages were added at the level of the lesser trochanter and/or the greater trochanter, and, in 3 cases, there was a change from uncemented to cemented femoral stems and only 1 required revision.

Conclusion Data Analysis Allows Us To State That The Risk Of Intraoperative Periprosthetic Fracture Is Greater In Women And With The Use Of Cementless Stems. The Occurrence Of These In This Study Had A Rate Of Less Than 1%.

Keywords

arthroplasty - intraoperative complications - hip fractures - periprosthetic fractures

^* Work developed at the Hospital Universitário Cajuru, Curitiba, PR, Brazil.

Publication History

Received: 24 October 2022

Accepted: 10 August 2023

Article published online:
31 January 2024

• Referências

• 1 Galia CR, Diesel CV, Guimarães MR, Ribeiro TA. Atualização em artroplastia total de quadril: uma técnica ainda em desenvolvimento. Rev Bras Ortop 2017; 52 (05) 521-527
• 2 Hoskins W, Bingham R, Lorimer M, Hatton A, de Steiger RN. Early rate of revision of total hip arthroplasty related to surgical approach: an analysis of 122,345 primary total hip arthroplasties. J Bone Joint Surg Am 2020; 102 (21) 1874-1882
• 3 Mayle RE, Della Valle CJ. Intra-operative fractures during THA: see it before it sees us. J Bone Joint Surg Br 2012; 94 (11, Suppl A) 26-31
• 4 Davidson D, Pike J, Garbuz D, Duncan CP, Masri BA. Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am 2008; 90 (09) 2000-2012
• 5 Liu B, Ma W, Li H, Wu T, Huo J, Han Y. Incidence, classification, and risk factors for intraoperative periprosthetic femoral fractures in patients undergoing total hip arthroplasty with a single stem: a retrospective study. J Arthroplasty 2019; 34 (07) 1400-1411
• 6 Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone 1993; 14 (03) 231-242
• 7 Miettinen SS, Mäkinen TJ, Kostensalo I. et al. Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty. Acta Orthop 2016; 87 (02) 113-119
• 8 Ponzio DY, Shahi A, Park AG, Purtill JJ. Intraoperative Proximal Femoral Fracture in Primary Cementless Total Hip Arthroplasty. J Arthroplasty 2015; 30 (08) 1418-1422
• 9 Sheth NP, Brown NM, Moric M, Berger RA, Della Valle CJ. Operative treatment of early peri-prosthetic femur fractures following primary total hip arthroplasty. J Arthroplasty 2013; 28 (02) 286-291
• 10 Haynes JA, Hopper Jr RH, Ho H, McDonald III JF, Parks NL, Hamilton WG. Direct Anterior Approach for Primary Total Hip Arthroplasty Lowers the Risk of Dislocation Compared to the Posterior Approach: A Single Institution Experience. J Arthroplasty 2022; 37 (03) 495-500
• 11 Lamb JN, Matharu GS, Redmond A, Judge A, West RM, Pandit HG. Risk Factors for Intraoperative Periprosthetic Femoral Fractures During Primary Total Hip Arthroplasty. An Analysis From the National Joint Registry for England and Wales and the Isle of Man. J Arthroplasty 2019; 34 (12) 3065-3073.e1
• 12 Nichols CI, Vose JG, Nunley RM. Clinical outcomes and 90-day costs following hemiarthroplasty or total hip arthroplasty for hip fracture. J Arthroplasty 2017; 32 (9S): S128-S134
• 13 Trousdale WH, Abdel MP, Viste A, Trousdale RT, Callaghan JJ, Berry DJ. Seasonality of periprosthetic femur fractures in 12,700 primary and revision total hip arthroplasties. J Arthroplasty 2017; 32 (06) 2000-2004
• 14 Abdel MP, Watts CD, Houdek MT, Lewallen DG, Berry DJ. Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. [published correction appears in Bone Joint J 2020;102-B(12):1782] Bone Joint J 2016; 98-B [phone]
• 15 Osterhoff G, Morgan EF, Shefelbine SJ, Karim L, McNamara LM, Augat P. Bone mechanical properties and changes with osteoporosis. Injury 2016; 47 (Suppl 2) S11-S20
• 16 Olsen F, Kotyra M, Houltz E, Ricksten SE. Bone cement implantation syndrome in cemented hemiarthroplasty for femoral neck fracture: incidence, risk factors, and effect on outcome. Br J Anaesth 2014; 113 (05) 800-806
• 17 Gundtoft PH, Varnum C, Pedersen AB, Overgaard S. The Danish Hip Arthroplasty Register. Clin Epidemiol 2016; 8: 509-514
• 18 Chana R, Mansouri R, Jack C. et al. The suitability of an uncemented hydroxyapatite coated (HAC) hip hemiarthroplasty stem for intra-capsular femoral neck fractures in osteoporotic elderly patients: the Metaphyseal-Diaphyseal Index, a solution to preventing intra-operative periprosthetic fracture. J Orthop Surg Res 2011; 6: 59
• 19 Wangen H, Havelin LI, Fenstad AM. et al. Reverse hybrid total hip arthroplasty. Acta Orthop 2017; 88 (03) 248-254
• 20 Colacchio ND, Robbins CE, Aghazadeh MS, Talmo CT, Bono JV. Total Hip Intraoperative Femur Fracture: Do the Design Enhancements of a Second-Generation Tapered-Wedge Stem Reduce the Incidence?. J Arthroplasty 2017; 32 (10) 3163-3168
• 21 Carli AV, Negus JJ, Haddad FS. Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture?. Bone Joint J 2017; 99-B (1, Supple A) 50-59
• 22 Zhao R, Cai H, Liu Y, Tian H, Zhang K, Liu Z. Risk factors for intraoperative proximal femoral fracture during primary cementless THA. Orthopedics 2017; 40 (02) e281-e287
• 23 Klein GR, Parvizi J, Vegari DN, Rothman RH, Purtill JJ. Total hip arthroplasty for acute femoral neck fractures using a cementless tapered femoral stem. J Arthroplasty 2006; 21 (08) 1134-1140
• 24 Richardson CG, Lethbridge LN, Dunbar MJ. Increased mortality with the use of cementless fixation for femoral neck fractures: analysis of 5883 hip arthroplasty cases. J Arthroplasty 2020; 35 (12) 3627-3630
• 25 Ekman E, Laaksonen I, Isotalo K, Liukas A, Vahlberg T, Mäkelä K. Cementing does not increase the immediate postoperative risk of death after total hip arthroplasty or hemiarthroplasty: a hospital-based study of 10,677 patients. Acta Orthop 2019; 90 (03) 270-274
• 26 Berend KR, Lombardi Jr AV. Intraoperative femur fracture is associated with stem and instrument design in primary total hip arthroplasty. Clin Orthop Relat Res 2010; 468 (09) 2377-2381
• 27 Bigart KC, Nahhas CR, Ruzich GP. et al. Does Femoral Morphology Predict the Risk of Periprosthetic Fracture After Cementless Total Hip Arthroplasty?. J Arthroplasty 2020; 35 (6S): S359-S363