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Periprosthetic fracture following arthroplasty for femoral neck fracture: is a cemented stem protective?

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Abstract

Background

Periprosthetic femoral fractures (PFF) carry significant morbidity following arthroplasty for femoral neck fracture (FNF). This study assessed fracture complications following arthroplasty for FNF and the effect of cement fixation of the femoral component on intraoperative and post-operative PFF.

Methods

Between February 2014 and September 2021, 740 patients with a FNF who underwent arthroplasty were analyzed for demographics, surgical management, use of cement for fixation of the femoral component, and subsequent PFF. Variables were compared with Mann–Whitney or Chi-square as appropriate. Multivariate logistic regression was used to assess independent risk factors associated with intraoperative or post-operative PFF.

Results

There were 163 THAs (41% cemented) and 577 HAs (95% cemented). There were 28 PFFs (3.8%): 18 post-operative and 10 intraoperative. Fewer post-operative PFFs occurred with cemented stems (1.63% vs. 6.30%, p = 0.002). Mean time from surgery to presentation with post-operative PFF was 14 months (0–45 months). Mean follow-up time was 10.3 months (range: 0–75.7 months). In multivariate regression, use of cement and THA was independently associated with decreased post-operative PFF (cement: OR 0.112, 95% CI 0.036–0.352, p < 0.001 and THA: OR 0.249, 95% CI 0.064–0.961, p = 0.044). More intraoperative fractures occurred during THA (3.68% vs. 0.69%, p = 0.004) and non-cemented procedures (5.51% vs. 0.49%, p < 0.001). In multivariate regression, use of cement was protective against intraoperative fracture (OR 0.100, CI 0.017–0.571, p = 0.010).

Conclusions

In patients with a FNF treated with arthroplasty, cementing the femoral component is associated with a lower risk of intraoperative and post-operative PFF. Choice of procedure may be based on patient factors and surgeon preference.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA

    Garrett W. Esper, Ariana T. Meltzer-Bruhn, Utkarsh Anil, Sanjit R. Konda, Abhishek Ganta & Kenneth A. Egol

  2. Division of Orthopedic Hip and Knee Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA

    Ran Schwarzkopf & William Macaulay

  3. Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA

    Sanjit R. Konda, Abhishek Ganta & Kenneth A. Egol

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  1. Garrett W. Esper
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Correspondence to Kenneth A. Egol.

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Esper, G.W., Meltzer-Bruhn, A.T., Anil, U. et al. Periprosthetic fracture following arthroplasty for femoral neck fracture: is a cemented stem protective?. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-023-03830-5

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