Abstract
Background
Periprosthetic femur fracture (PFF) remains a common reason for failure after total
hip arthroplasty (THA). For over 10 years, our institution has performed both anterior
approach (AA) and posterolateral (PL) approaches for primary THA with multiple stem
designs. The aim of this study is to determine the 90-day relative risk of PFF with
regard to approach and stem design.
Methods
A retrospective review of our institutional database was performed on all patients
undergoing primary THA from 2007 to 2018 using AA or PL approaches. Five surgeons
performing 6309 THAs (AA = 4510; PL = 1799) using single-wedge taper (n = 2417) or
fit-and-fill (n = 3892) stems were included. PFF occurring within 90 days of the index
procedure were analyzed. Differences in PFF rates, fracture location, stem type, and
treatment method were assessed. Comparisons were made using a Cox regression analysis.
Results
The 90-day revision rate for fracture was 0.3%. Clinically significant fractures requiring
cerclage cabling, stem change, revision, or open reduction internal fixation occurred
in 0.9% of patients (intraoperative = 37, 0.6%; postoperative = 17, 0.3%). Cox regression
found PFF risk was significant for female patients (P = .008), patients older than age 65 (P < .01), single-wedge taper stems (P = .05), and for cases with collarless stems (P = .04). Among PFF cases that required surgical intervention, risk factors were female
sex, age older than 65, and body mass index under 25 (P < .05). Collarless stems were 2.6 times more likely to result in PFF than collared
stems (P = .04). Single-wedge taper stems were 2.3 times more likely to result in PFF than
fit-and-fill stems (P = .05). Approach was not found to be an independent risk factor for PFF (P = .85).
Conclusion
Our single-center experience demonstrates the risk of periprosthetic fracture within
90 days of surgery is significantly lower with collared stems and fit-and-fill stem
designs. Female sex, age over 65, and body mass index below 25 nearly double the PFF
risk. Surgical approach did not influence fracture rates.
Keywords:
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Article info
Publication history
Published online: February 22, 2021
Accepted:
February 4,
2021
Received in revised form:
January 26,
2021
Received:
November 16,
2020
Footnotes
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The Inova Health System provides financial support for the Anderson Orthopedic Research Institute (AORI) but does not restrict or define the scope of the research undertaken by AORI.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2021.02.012.
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