Abstract
Non-cemented femoral fixation in hip arthroplasty has become the standard of practice in the USA. However, recent literature has brought attention to an increasing incidence of periprosthetic femur fractures with certain stem designs. This study examines reasons for early periprosthetic femur fractures in patients with a hip arthroplasty performed using a non-cemented tapered wedge stem design. A multivariate analysis using a matched-cohort design was performed to assess any potential risk factors that may predispose to such fractures. Six of 2,220 hips (0.3%) suffered a periprosthetic femur fracture within the first year after surgery; five of six were Vancouver Type B2. The average time to fracture was 9 weeks. This group of patients had a significantly higher canal–flare index and lower canal–calcar ratio. This complication may be preventable by having a better appreciation of the fit between the implant and the bone during pre-operative planning, with the goal of avoiding a proximal–distal mismatch.
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Berend ME, Smith A, Meading JB, Ritter MA, Lynch T, Davis K. Long term outcome and risk factors of proximal femoral fracture in uncemented and cemented total hip arthroplasty in 2551 hips. J Arthroplasty 2006; 21: 53-59
Berry DJ, Dorr LD, Long WT, Dastane M, Taunton MJ. Early femur fracture after THA: Increased prevalence associated with modern N. American practice. 75th Annual Meeting of the American Academy of Orthopaedic Surgeons. March 2008, San Francisco, CA
Bourne RB, Rorabeck CH, Patterson JJ, Guerin J. Tapered titanium cementless total hip replacements: a 10- to 13-year followup study. Clin Orthop Relat Res 2001; 393: 112-120
Brady OH, Garbuz DS, Masri BA, Duncan CP. The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty. 2000; 15: 59–62
Cook RE, Jenkins PJ, Walmsley PJ, Patton JT, Robinson CM. Risk factors for periprosthetic fractures of the hip. Clin Orthop 2008; 466: 1652-1656
Davis ET, McKee MD, Waddell JP, Hupel T, Schemitsch EH. Total Hip Arthroplasty Following Failure of Free Vascularized Fibular Graft, J Bone Joint Surg Am 2006; 88: 110-115
Dorr LD. Total hip replacement using APR system. Tech Orthop 1986; 1: 22-34
Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect 1995; 44: 293–304
Fernandez-Fernandez R, García-Elias E, Gil-Garay E. Peroperative fractures in uncemented total hip arthrography: results with a single design of stem implant. Int Orthop 2008; 32: 307-313
Froimson MI, Garino J, Machenaud A, Vidalain JP. Minimum 10-year results of a tapered, titanium, hydroxyapatite-coated hip stem: an independent review. J Arthroplasty 2007; 22: 1-7
Haddad FS, Masri BA, Garbuz DS, Duncan CP. The prevention of periprosthetic fractures in total hip and knee arthroplasty. Orthop Clin North Am 1999; 30: 191-207
Lachiewicz PF, Soileau ES, Bryant P. Second-generation proximally coated titanium femoral component: minimum 7-year results. Clin Orthop Relat Res 2007; 465: 117-121
Lewallen DG, Berry DJ. Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date. Instructional Course Lectures 1998; 47:243
Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 2005; 20: 857-865
Marshall AD, Mokris JG, Reitman RD, Dandar A, Mauerhan DR. Cementless titanium tapered-wedge femoral stem: 10- to 15-year follow-up. J Arthroplasty 2004; 19: 546-552
McLaughlin JR, Lee KR. Total hip arthroplasty in young patients. 8- to 13-year results using an uncemented stem. Clin Orthop Relat Res 2000; 373: 153-163
Meding JB, Keating EM, Ritter MA, Faris PM, Berend ME. Minimum ten-year follow-up of a straight-stemmed, plasma-sprayed, titanium-alloy, uncemented femoral component in primary total hip arthroplasty. J Bone Joint Surg Am 2004; 86: 92-97
Noble PC, Alexander JW, Lindahl LJ, Yew JT, Granberry WM, Tullos HS. The anatomic basis of femoral component design. Clin Orthop Relat Res 1988; 235: 148-165
Noble PC, Box GG, Kamaric E, Fink MJ, Alexander JW, Tullos HS. The effect of aging on the shape of the proximal femur. Clin Orthop Relat Res 1995; 316: 31-44
Spotorno L, Romagnoli S. Indications for the CLS stem. In: Spotorno L, Romagnoli S, eds. The CLS uncemented total hip replacement system. Berne, Switzerland: Protek; 1991
Yeung Y, Chiu KY, Yau WP, Tang WM, Cheung WY, Ng TP. Assessment of the proximal femoral morphology using plain radiograph-can it predict the bone quality? J Arthroplasty 2006; 21:508-513
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No financial support was received in this study. Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
Prior to the commencement of this study, approval for this study was obtained from the Institutional Review Board of our institution. Research was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki. Each author certifies that his or her institution has approved the reporting of these cases and that all investigations were conducted in conformity with ethical principles of research.
Level of evidence: Level III: Prognostic Study.
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Cooper, H.J., Rodriguez, J.A. Early Post-operative Periprosthetic Femur Fracture in the Presence of a Non-cemented Tapered Wedge Femoral Stem. HSS Jrnl 6, 150–154 (2010). https://doi.org/10.1007/s11420-010-9161-4
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DOI: https://doi.org/10.1007/s11420-010-9161-4