Risk factors for Periprosthetic Fractures of the Hip: A Survivorship Analysis
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Periprosthetic fracture is an uncommon but typically complex complication of cemented THA usually treated operatively. It is a source of reduced function, subsequent morbidity, and increased mortality. Previous studies may have underestimated the incidence of fracture through loss to followup or failure to use survivorship methodologies. The primary aim of this study was to use survivorship methodology to investigate the incidence of, and risk factors for fracture following primary arthroplasty. We examined a cohort of 6458 primary cemented femoral prostheses implanted during a 17-year period. One hundred twenty-four patients sustained fractures at the tip or below the femoral prosthesis. The incidence of fracture was 0.8% at 5 years and 3.5% at 10 years after primary implant. Patients older than 70 years had a 2.9 times greater risk of sustaining a subsequent fracture. There was no association between fracture and gender or implant type. These rates are higher than those reported for cemented arthroplasties. Older patients should be counseled regarding their higher risk of periprosthetic fracture, and additional research is required to elucidate the biologic mechanisms involved.
Level of Evidence: Level II, retrospective prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
- Berry, DJ (1999) Epidemiology: hip and knee. Orthop Clin North Am 30: pp. 183-190 CrossRef
- Brady, OH, Garbuz, DS, Masri, BA, Duncan, CP (1999) Classification of the hip. Orthop Clin North Am 30: pp. 215-220 CrossRef
- Brady, OH, Garbuz, DS, Masri, BA, Duncan, CP (2000) The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty 15: pp. 59-62 CrossRef
- Crockarell, JR, Berry, DJ, Lewallen, DG (1999) Nonunion after periprosthetic femoral fracture associated with total hip arthroplasty. J Bone Joint Surg Am 81: pp. 1073-1079
- DeFrances, CJ, Hall, MJ (2004) 2002 National Hospital Discharge Survey. Adv Data 342: pp. 1-29
- Franklin, J, Malchau, H (2007) Risk factors for periprosthetic femoral fracture. Injury 38: pp. 655-660 CrossRef
- Fredin, HO, Lindberg, H, Carlsson, AS (1987) Femoral fracture following hip arthroplasty. Acta Orthop Scand 58: pp. 20-22 CrossRef
- Garcia-Cimbrelo, E, Munuera, L, Gil-Garay, E (1992) Femoral shaft fractures after cemented total hip arthroplasty. Int Orthop 16: pp. 97-100 CrossRef
- Graves, EJ (1991) Detailed diagnoses and procedures, National Hospital Discharge Survey, 1989. Vital Health Stat 108: pp. 1-236
- Havelin, LI, Engesaeter, LB, Espehaug, B, Furnes, O, Lie, SA, Vollset, SE (2000) The Norwegian Arthroplasty Register: 11 years and 73,000 arthroplasties. Acta Orthop Scand 71: pp. 337-353 CrossRef
- Kavanagh, BF (1992) Femoral fractures associated with total hip arthroplasty. Orthop Clin North Am 23: pp. 249-257
- Lewallen, DG, Berry, DJ (1998) Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date. Instr Course Lect 47: pp. 243-249
- Lindahl, H (2007) Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury 38: pp. 651-654 CrossRef
- Lindahl, H, Garellick, G, Regner, H, Herberts, P, Malchau, H (2006) Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am 88: pp. 1215-1222 CrossRef
- Lindahl, H, Malchau, H, Herberts, P, Garellick, G (2005) Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 20: pp. 857-865 CrossRef
- Lindahl, H, Oden, A, Garellick, G, Malchau, H (2007) The excess mortality due to periprosthetic femur fracture a study from the Swedish national hip arthroplasty register. Bone 40: pp. 1294-1298 CrossRef
- Lowenhielm, G, Hansson, LI, Karrholm, J (1989) Fracture of the lower extremity after total hip replacement. Arch Orthop Trauma Surg 108: pp. 141-143 CrossRef
- Lucht, U (2000) The Danish Hip Arthroplasty Register. Acta Orthop Scand 71: pp. 433-439 CrossRef
- Morrey, BF, Kavanagh, BF (1992) Complications with revision of the femoral component of total hip arthroplasty: comparison between cemented and uncemented techniques. J Arthroplasty 7: pp. 71-79 CrossRef
- Sarvilinna, R, Huhtala, HS, Puolakka, TJ, Nevalainen, JK, Pajamaki, KJ (2003) Periprosthetic fractures in total hip arthroplasty: an epidemiologic study. Int Orthop 27: pp. 359-361 CrossRef
- Schmidt, AH, Kyle, RF (2002) Periprosthetic fractures of the femur. Orthop Clin North Am 33: pp. 143-152 CrossRef
- Scottish Arthroplasty Project Annual Report. http://www.arthro.scot.nhs.uk/Reports/Scottish_Arthroplasty_Project_Report_2007.pdf. Accessed 03/04/2008.
- Scottish Arthroplasty Project Report 2007. Edinburgh, Scotland: NHS Scotland; 2007.
- Sharma, S, Fraser, M, Lovell, F, Reece, A, McLellan, AR (2008) Characteristics of males over 50 years who present with a fracture: epidemiology and underlying risk factors. J Bone Joint Surg Br 90: pp. 72-77 CrossRef
- Timperley AJ, Gie GA, Lee ASC, Ling RSM. The femoral component as a taper in cemented total hip arthroplasty. J Bone Joint Surg Br. 1993;75-B (Suppl I):33.
- Yamaguchi, K, Masuhara, K, Yamasaki, S, Nakai, T, Fuji, T (2003) Cyclic therapy with etidronate has a therapeutic effect against local osteoporosis after cementless total hip arthroplasty. Bone 33: pp. 144-149 CrossRef
- Risk factors for Periprosthetic Fractures of the Hip: A Survivorship Analysis
Clinical Orthopaedics and Related Research
Volume 466, Issue 7 , pp 1652-1656
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Elective Arthroplasty Unit and the Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SU, Scotland, UK