Periprosthetic femoral fracture as cause of early revision after short stem hip arthroplasty—a multicentric analysis

  • Sang-Min Kim
  • Seung-Beom Han
  • Kee Hyung Rhyu
  • Jeong Joon Yoo
  • Kwang-Jun Oh
  • Je Hyun Yoo
  • Kyung-Jae Lee
  • Seung-Jae Lim
Original Paper
  • 59 Downloads

Abstract

Background

The objective of this study was to analyze the prevalence and causes of early re-operation after hip replacement surgery using short bone-preserving stems in a large multicentre series. Specifically, we evaluated the clinical features of periprosthetic fractures occurring around short stems.

Methods

A total of 897 patients (1089 hips) who underwent primary total hip arthroplasty or bipolar hemiarthroplasty from January 2011 to February 2015 using short bone-preserving femoral stems were recruited. Mean patient age was 57.4 years (range, 18–97 years), with a male ratio of 49.7% (541/1089). Re-operation for any reason within two years was used as an endpoint. The incidence and clinical characteristics of the periprosthetic femoral fractures were also recorded. Mean follow-up period was 5.1 years (range, 2–7.9 years).

Results

Early re-operation for any reason was identified in 16 (1.5%) of 1089 hips. The main reason for re-operation was periprosthetic femoral fracture, which accounted for eight (50%) of the 16 re-operations. The overall incidence of periprosthetic femoral fracture at two years was 1.1% (12/1089). According to the Vancouver classification, two fractures were AG type and the other ten were B1 type. Advanced age, higher American Society of Anesthesiologist grade, femur morphology of Dorr type C, and the use of a calcar-loading stem increased the risk for periprosthetic femoral fracture.

Conclusion

Periprosthetic femoral fracture was the major reason for re-operation after hip replacement surgery using short bone-preserving stems accounting for 50% (8/16) of re-operations two years post-operatively, but did not seem to deteriorate survivorship of implanted prostheses.

Keywords

Reoperation Periprosthetic femoral fracture Short stem Hip replacement 

Notes

Compliance with ethical standards

This study was approved by the institutional review board

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    McCalden RW, Korczak A, Somerville L, Yuan X, Naudie DD (2015) A randomised trial comparing a short and a standard-length metaphyseal engaging cementless femoral stem using radiostereometric analysis. Bone Joint J 97-B:595–602CrossRefPubMedGoogle Scholar
  2. 2.
    van Oldenrijk J, Molleman J, Klaver M, Poolman RW, Haverkamp D (2014) Revision rate after short-stem total hip arthroplasty: a systematic review of 49 studies. Acta Orthop 85:250–258CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ulrich SD, Seyler TM, Bennett D, Delanois RE, Saleh KJ, Thongtrangan I, Kuskowski M, Cheng EY, Sharkey PF, Parvizi J, Stiehl JB, Mont MA (2008) Total hip arthroplasties: what are the reasons for revision? Int Orthop 32:597–604CrossRefPubMedGoogle Scholar
  4. 4.
    Streit MR, Merle C, Clarius M, Aldinger PR (2011) Late peri-prosthetic femoral fracture as a major mode of failure in uncemented primary hip replacement. J Bone Joint Surg Br 93:178–183CrossRefPubMedGoogle Scholar
  5. 5.
    Leonardsson O, Karrholm J, Akesson K, Garellick G, Rogmark C (2012) Higher risk of reoperation for bipolar and uncemented hemiarthroplasty. Acta Orthop 83:459–466CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Jakubowitz E, Seeger JB, Lee C, Heisel C, Kretzer JP, Thomsen MN (2009) Do short-stemmed-prostheses induce periprosthetic fractures earlier than standard hip stems? A biomechanical ex-vivo study of two different stem designs. Arch Orthop Trauma Surg 129:849–855CrossRefPubMedGoogle Scholar
  7. 7.
    Bishop NE, Burton A, Maheson M, Morlock MM (2010) Biomechanics of short hip endoprostheses—the risk of bone failure increases with decreasing implant size. Clin Biomech (Bristol, Avon) 25:666–674CrossRefGoogle Scholar
  8. 8.
    Thien TM, Chatziagorou G, Garellick G, Furnes O, Havelin LI, Makela K, Overgaard S, Pedersen A, Eskelinen A, Pulkkinen P, Karrholm J (2014) Periprosthetic femoral fracture within two years after total hip replacement: analysis of 437,629 operations in the Nordic Arthroplasty Register association database. J Bone Joint Surg Am 96:e167CrossRefPubMedGoogle Scholar
  9. 9.
    Khanuja HS, Banerjee S, Jain D, Pivec R, Mont MA (2014) Short bone-conserving stems in cementless hip arthroplasty. J Bone Joint Surg Am 96:1742–1752CrossRefPubMedGoogle Scholar
  10. 10.
    Beaule PE, Dorey FJ, Hoke R, Le Duff M, Amstutz HC (2006) The value of patient activity level in the outcome of total hip arthroplasty. J Arthroplast 21:547–552CrossRefGoogle Scholar
  11. 11.
    Daabiss M (2011) American Society of Anaesthesiologists physical status classification. Indian J Anaesth 55:111–115CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Dorr LD, Absatz M, Gruen TA, Saberi MT, Doerzbacher JF (1990) Anatomic porous replacement hip arthroplasty: first 100 consecutive cases. Semin Arthroplast 1:77–86Google Scholar
  13. 13.
    Khalily C, Lester DK (2002) Results of a tapered cementless femoral stem implanted in varus. J Arthroplast 17:463–466CrossRefGoogle Scholar
  14. 14.
    Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res:17–27Google Scholar
  15. 15.
    Kim SM, Lim SJ, Moon YW, Kim YT, Ko KR, Park YS (2013) Cementless modular total hip arthroplasty in patients younger than fifty with femoral head osteonecrosis: minimum fifteen-year follow-up. J Arthroplast 28:504–509CrossRefGoogle Scholar
  16. 16.
    Masri BA, Meek RM, Duncan CP (2004) Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res:80–95Google Scholar
  17. 17.
    Berry DJ (1999) Epidemiology: hip and knee. Orthop Clin North Am 30:183–190CrossRefPubMedGoogle Scholar
  18. 18.
    Kavanagh BF (1992) Femoral fractures associated with total hip arthroplasty. Orthop Clin North Am 23:249–257PubMedGoogle Scholar
  19. 19.
    Lindahl H (2007) Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury 38:651–654CrossRefPubMedGoogle Scholar
  20. 20.
    Lowenhielm G, Hansson LI, Karrholm J (1989) Fracture of the lower extremity after total hip replacement. Arch Orthop Trauma Surg 108:141–143CrossRefPubMedGoogle Scholar
  21. 21.
    Daniel J, Pradhan C, Ziaee H, McMinn DJ (2008) A clinicoradiologic study of the Birmingham mid-head resection device. Orthopedics 31Google Scholar
  22. 22.
    McMinn DJ, Pradhan C, Ziaee H, Daniel J (2011) Is mid-head resection a durable conservative option in the presence of poor femoral bone quality and distorted anatomy? Clin Orthop Relat Res 469:1589–1597CrossRefPubMedGoogle Scholar
  23. 23.
    Rahman L, Muirhead-Allwood SK (2011) The Birmingham mid-head resection arthroplasty—minimum two year clinical and radiological follow-up: an independent single surgeon series. Hip Int 21:356–360CrossRefPubMedGoogle Scholar
  24. 24.
    Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH (1993) Structural and cellular assessment of bone quality of proximal femur. Bone 14:231–242CrossRefPubMedGoogle Scholar
  25. 25.
    Patel RM, Smith MC, Woodward CC, Stulberg SD (2012) Stable fixation of short-stem femoral implants in patients 70 years and older. Clin Orthop Relat Res 470:442–449CrossRefPubMedGoogle Scholar
  26. 26.
    Stulberg SD, Dolan M (2008) The short stem: a thinking man’s alternative to surface replacement. Orthopedics 31:885–886CrossRefPubMedGoogle Scholar
  27. 27.
    Berry DJ (2003) Periprosthetic fractures associated with osteolysis: a problem on the rise. J Arthroplast 18:107–111CrossRefGoogle Scholar
  28. 28.
    Lindahl H, Garellick G, Regner H, Herberts P, Malchau H (2006) Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am 88:1215–1222CrossRefPubMedGoogle Scholar
  29. 29.
    Abdel MP, Houdek MT, Watts CD, Lewallen DG, Berry DJ (2016) Epidemiology of periprosthetic femoral fractures in 5417 revision total hip arthroplasties: a 40-year experience. Bone Joint J 98-B:468–474CrossRefPubMedGoogle Scholar
  30. 30.
    Berend ME, Smith A, Meding JB, Ritter MA, Lynch T, Davis K (2006) Long-term outcome and risk factors of proximal femoral fracture in uncemented and cemented total hip arthroplasty in 2551 hips. J Arthroplast 21:53–59CrossRefGoogle Scholar
  31. 31.
    Carli AV, Negus JJ, Haddad FS (2017) Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture? Bone Joint J 99-B:50–59CrossRefPubMedGoogle Scholar
  32. 32.
    Jones C, Aqil A, Clarke S, Cobb JP (2015) Short uncemented stems allow greater femoral flexibility and may reduce peri-prosthetic fracture risk: a dry bone and cadaveric study. J Orthop Traumatol 16:229–235CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Franklin J, Malchau H (2007) Risk factors for periprosthetic femoral fracture. Injury 38:655–660CrossRefPubMedGoogle Scholar
  34. 34.
    Meek RM, Norwood T, Smith R, Brenkel IJ, Howie CR (2011) The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br 93:96–101CrossRefPubMedGoogle Scholar
  35. 35.
    Cook RE, Jenkins PJ, Walmsley PJ, Patton JT, Robinson CM (2008) Risk factors for periprosthetic fractures of the hip: a survivorship analysis. Clin Orthop Relat Res 466:1652–1656CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Gromov K, Bersang A, Nielsen CS, Kallemose T, Husted H, Troelsen A (2017) Risk factors for postoperative periprosthetic fractures following primary total hip arthroplasty with a proximally coated double-tapered cementless femoral component. Bone Joint J 99-B:451–457CrossRefPubMedGoogle Scholar
  37. 37.
    Kim YH, Oh JH (2012) A comparison of a conventional versus a short, anatomical metaphyseal-fitting cementless femoral stem in the treatment of patients with a fracture of the femoral neck. J Bone Joint Surg Br 94:774–781CrossRefPubMedGoogle Scholar
  38. 38.
    Feyen H, Shimmin AJ (2014) Is the length of the femoral component important in primary total hip replacement? Bone Joint J 96-B:442–448CrossRefPubMedGoogle Scholar
  39. 39.
    Nieuwenhuijse MJ, Valstar ER, Kaptein BL, Nelissen RG (2012) The Exeter femoral stem continues to migrate during its first decade after implantation: 10–12 years of follow-up with radiostereometric analysis (RSA). Acta Orthop 83:129–134CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Sang-Min Kim
    • 1
  • Seung-Beom Han
    • 2
  • Kee Hyung Rhyu
    • 3
  • Jeong Joon Yoo
    • 4
  • Kwang-Jun Oh
    • 5
  • Je Hyun Yoo
    • 6
  • Kyung-Jae Lee
    • 7
  • Seung-Jae Lim
    • 8
  1. 1.Department of Orthopaedic SurgeryKorea University Guro Hospital, Korea University School of MedicineSeoulSouth Korea
  2. 2.Department of Orthopedic Surgery, College of Medicine, Anam HospitalKorea UniversitySeoulSouth Korea
  3. 3.Department of Orthopedic Surgery, College of MedicineKyung Hee University Hospital at Gangdong, Kyung-Hee UniversitySeoulSouth Korea
  4. 4.Department of Orthopedic SurgerySeoul National University College of MedicineSeoulSouth Korea
  5. 5.Department of Orthopedic SurgeryKonkuk University Hospital, Konkuk University School of MedicineSeoulSouth Korea
  6. 6.Department of Orthopedic SurgeryHallym University Sacred Heart hospitalAnyangSouth Korea
  7. 7.Department of Orthopedic Surgery, Dongsan Medical CenterKeimyung University School of MedicineDaeguSouth Korea
  8. 8.Department of Orthopedic Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea

Personalised recommendations