Clinical Orthopaedics and Related Research

, Volume 466, Issue 7, pp 1652–1656 | Cite as

Risk factors for Periprosthetic Fractures of the Hip: A Survivorship Analysis

  • R. E. Cook
  • P. J. Jenkins
  • P. J. Walmsley
  • J. T. Patton
  • C. M. Robinson
Original Article

Abstract

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.

References

  1. 1.
    Berry DJ. Epidemiology: hip and knee. Orthop Clin North Am. 1999;30:183–190.PubMedCrossRefGoogle Scholar
  2. 2.
    Brady OH, Garbuz DS, Masri BA, Duncan CP. Classification of the hip. Orthop Clin North Am. 1999;30:215–220.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    Crockarell JR Jr, Berry DJ, Lewallen DG. Nonunion after periprosthetic femoral fracture associated with total hip arthroplasty. J Bone Joint Surg Am. 1999;81:1073–1079.PubMedGoogle Scholar
  5. 5.
    DeFrances CJ, Hall MJ. 2002 National Hospital Discharge Survey. Adv Data. 2004;342:1–29.PubMedGoogle Scholar
  6. 6.
    Franklin J, Malchau H. Risk factors for periprosthetic femoral fracture. Injury. 2007;38:655–660.PubMedCrossRefGoogle Scholar
  7. 7.
    Fredin HO, Lindberg H, Carlsson AS. Femoral fracture following hip arthroplasty. Acta Orthop Scand. 1987;58:20–22.PubMedCrossRefGoogle Scholar
  8. 8.
    Garcia-Cimbrelo E, Munuera L, Gil-Garay E. Femoral shaft fractures after cemented total hip arthroplasty. Int Orthop. 1992;16:97–100.PubMedCrossRefGoogle Scholar
  9. 9.
    Graves EJ. Detailed diagnoses and procedures, National Hospital Discharge Survey, 1989. Vital Health Stat. 1991;108:1–236.Google Scholar
  10. 10.
    Havelin LI, Engesaeter LB, Espehaug B, Furnes O, Lie SA, Vollset SE. The Norwegian Arthroplasty Register: 11 years and 73,000 arthroplasties. Acta Orthop Scand. 2000;71:337–353.PubMedCrossRefGoogle Scholar
  11. 11.
    Kavanagh BF. Femoral fractures associated with total hip arthroplasty. Orthop Clin North Am. 1992;23:249–257.PubMedGoogle Scholar
  12. 12.
    Lewallen DG, Berry DJ. Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date. Instr Course Lect. 1998;47:243–249.PubMedGoogle Scholar
  13. 13.
    Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007;38:651–654.PubMedCrossRefGoogle Scholar
  14. 14.
    Lindahl H, Garellick G, Regner H, Herberts P, Malchau H. Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am. 2006;88:1215–1222.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    Lindahl H, Oden A, Garellick G, Malchau H. The excess mortality due to periprosthetic femur fracture a study from the Swedish national hip arthroplasty register. Bone. 2007;40:1294–1298.PubMedCrossRefGoogle Scholar
  17. 17.
    Lowenhielm G, Hansson LI, Karrholm J. Fracture of the lower extremity after total hip replacement. Arch Orthop Trauma Surg. 1989;108:141–143.PubMedCrossRefGoogle Scholar
  18. 18.
    Lucht U. The Danish Hip Arthroplasty Register. Acta Orthop Scand. 2000;71:433–439.PubMedCrossRefGoogle Scholar
  19. 19.
    Morrey BF, Kavanagh BF. Complications with revision of the femoral component of total hip arthroplasty: comparison between cemented and uncemented techniques. J Arthroplasty. 1992;7:71–79.PubMedCrossRefGoogle Scholar
  20. 20.
    Sarvilinna R, Huhtala HS, Puolakka TJ, Nevalainen JK, Pajamaki KJ. Periprosthetic fractures in total hip arthroplasty: an epidemiologic study. Int Orthop. 2003;27:359–361.PubMedCrossRefGoogle Scholar
  21. 21.
    Schmidt AH, Kyle RF. Periprosthetic fractures of the femur. Orthop Clin North Am. 2002;33:143–152, ix.PubMedCrossRefGoogle Scholar
  22. 22.
    Scottish Arthroplasty Project Annual Report. http://www.arthro.scot.nhs.uk/Reports/Scottish_Arthroplasty_Project_Report_2007.pdf. Accessed 03/04/2008.
  23. 23.
    Scottish Arthroplasty Project Report 2007. Edinburgh, Scotland: NHS Scotland; 2007.Google Scholar
  24. 24.
    Sharma S, Fraser M, Lovell F, Reece A, McLellan AR. Characteristics of males over 50 years who present with a fracture: epidemiology and underlying risk factors. J Bone Joint Surg Br. 2008;90:72–77.PubMedCrossRefGoogle Scholar
  25. 25.
    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.Google Scholar
  26. 26.
    Yamaguchi K, Masuhara K, Yamasaki S, Nakai T, Fuji T. Cyclic therapy with etidronate has a therapeutic effect against local osteoporosis after cementless total hip arthroplasty. Bone. 2003;33:144–149.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • R. E. Cook
    • 1
  • P. J. Jenkins
    • 1
  • P. J. Walmsley
    • 1
  • J. T. Patton
    • 1
  • C. M. Robinson
    • 1
  1. 1.Elective Arthroplasty Unit and the Orthopaedic Trauma UnitRoyal Infirmary of EdinburghEdinburghScotland, UK

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