Abstract
Background:
The aim of this study was to estimate risk factors for intraoperative periprosthetic femoral fractures (IOPFF) and each anatomical subtype (calcar crack, trochanteric fracture, femoral shaft fracture) during primary total hip arthroplasty (THA).
Methods
This retrospective cohort study included 793823 primary THAs between 2004 and 2016. Multivariable regression modelling was used to estimate relative risk of patient, surgical and implant factors for any IOPFF and for all anatomical subtypes of IOPFF. Clinically important interactions were assessed using multivariable regression.
Results
Patient factors significantly increasing the risk of fracture were: female gender, American Association of Anaesthesiologists (ASA) grade 3 to 5, pre-operative diagnosis including: avascular necrosis of the hip (AVN), previous trauma, inflammatory disease, paediatric disease and previous infection. Overall risk of IOPFF associated with age was greatest in patients below 50 years and above 80 years. Risk of any fracture reduced with computer guided surgery (CGS) and in non-NHS hospitals. Non-posterior approach’s increased the risk of shaft and trochanteric fracture only. Cementless implants only significantly increased the risk of calcar cracks and shaft fractures and not trochanteric fractures.
Conclusions
Fracture risk increases in patients less than 50 and older than 80, females, ASA grade 3 to 5 and indications other than primary osteoarthritis. Large cumulative reduction in IOPFF risk may occur with use of cemented implants, posterior approach and CGS.
The aim of this study was to estimate risk factors for intraoperative periprosthetic femoral fractures (IOPFF) and each anatomical subtype (calcar crack, trochanteric fracture, femoral shaft fracture) during primary total hip arthroplasty (THA).
Methods
This retrospective cohort study included 793823 primary THAs between 2004 and 2016. Multivariable regression modelling was used to estimate relative risk of patient, surgical and implant factors for any IOPFF and for all anatomical subtypes of IOPFF. Clinically important interactions were assessed using multivariable regression.
Results
Patient factors significantly increasing the risk of fracture were: female gender, American Association of Anaesthesiologists (ASA) grade 3 to 5, pre-operative diagnosis including: avascular necrosis of the hip (AVN), previous trauma, inflammatory disease, paediatric disease and previous infection. Overall risk of IOPFF associated with age was greatest in patients below 50 years and above 80 years. Risk of any fracture reduced with computer guided surgery (CGS) and in non-NHS hospitals. Non-posterior approach’s increased the risk of shaft and trochanteric fracture only. Cementless implants only significantly increased the risk of calcar cracks and shaft fractures and not trochanteric fractures.
Conclusions
Fracture risk increases in patients less than 50 and older than 80, females, ASA grade 3 to 5 and indications other than primary osteoarthritis. Large cumulative reduction in IOPFF risk may occur with use of cemented implants, posterior approach and CGS.
| Original language | English |
|---|---|
| Pages (from-to) | 3065-3073 |
| Number of pages | 10 |
| Journal | Journal of Arthroplasty |
| Volume | 34 |
| Issue number | 12 |
| Early online date | 9 Jul 2019 |
| DOIs | |
| Publication status | Published - 1 Dec 2019 |
Keywords
- risk factors
- intraoperative periprosthetic fracture
- complications
- total hip arthroplasty
- revision risk