Patient and implant survival following intraoperative periprosthetic femoral fractures during primary total hip arthroplasty: An analysis from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

Jonathan N. Lamb, Gulraj S. Matharu, Anthony Redmond, Andrew Judge, Robert M. West, Hemant G Pandit

Research output: Contribution to journalArticle (Academic Journal)peer-review

6 Citations (Scopus)
29 Downloads (Pure)

Abstract

AimsWe compared implant and patient survival following intraoperative periprosthetic femoral fractures (IOPFF) during primary total hip arthroplasty (THA) with matched controls. 
MethodsThis retrospective cohort study compared 4831 hips with IOPFF and 48154 propensity score matched primary THAs without IOPFF implanted between 2004 and 2016. Implant and patient survival rates were compared between groups using Cox regression.
Results10-year stem survival was worse in the IOPFF group (p<0.001). Risk of revision for aseptic loosening increased 7.2 fold following shaft fracture and almost 2.8 fold after trochanteric fracture (p<0.001). Risk of periprosthetic fracture of the femur revision increased 4.3 fold following calcar-crack and 3.6 fold after trochanteric fracture (p<0.01). Risk of instability revision was 3.6 fold after trochanteric fracture and 2.4 fold after calcar crack (p<0.001). Risk of 90-day mortality following IOPFF without revision was 1.7 fold and 4.0 fold after IOPFF with early revision surgery versus uncomplicated THA (p<0.001).
ConclusionsIOPFF increases risk of stem revision and mortality up to 10 years following surgery. The risk of revision depends on IOPFF subtype and mortality risk increases with subsequent revision surgery. Surgeons should carefully diagnose and treat IOPFF to minimise fracture progression and implant failure.
Original languageEnglish
Pages (from-to)1199-1208
Number of pages10
JournalBone and Joint Journal
Volume101-B
Issue number10
Early online date30 Sep 2019
DOIs
Publication statusPublished - 1 Oct 2019

Keywords

  • Hip
  • Stem revision
  • Trochanteric fracture
  • Shaft fracture
  • Calcar crack
  • IOPFF
  • Intraoperative fracture

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