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International Orthopaedics

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01-01-2020 | Femoral Fracture | Original Paper

Incidence and pattern of periprosthetic hip fractures around the stem in different stem geometry

Authors: Umberto Cottino, Federico Dettoni, Giorgia Caputo, Davide E. Bonasia, Paolo Rossi, Roberto Rossi

Published in: International Orthopaedics | Issue 1/2020

Abstract

Background

The number of total hip arthroplasties (THA) is expected to increase worldwide; thus, complications are likely to increase at the same ratio. In this scenario, periprosthetic femoral fractures (PFFs) are an increasing concern. Identifying the predisposing factors is important in order to prevent as much as possible the risk of PFF in the future.

Patients and methods

The purpose of this study was to correlate the risk of periprosthetic femoral fractures to the most common patients’ comorbidities and stem geometry. We reviewed all THA for non-oncologic indications between 2004 and 2014 with a mean follow-up of six years (range, 2–12). Three thousand two hundred forty-eight patients (3593 implants) were enrolled in the study, and 45 PFF were registered during this time period. Two thousand five hundred seventy-seven implants (71%) were straight stems, and 1015 (28.3%) were anatomic stems. All X-rays were then analyzed and classified according to the modified Vancouver classification.

Results

Periprosthetic femoral fractures incidence was associated with anatomic stem geometry (p < 0.001, OR = 2.2), BMI (p < 0.001), and diabetes (p < 0.001, OR = 5.18). PFFs were not significantly associated with age, gender, and all the other variables. Fracture pattern was different between straight and anatomic stems. Clamshell fractures were more likely to occur in anatomic stems compared to straight stems (p < 0.005).

Conclusions

Periprosthetic femoral fractures are highly associated with obesity and osteoporosis. Anatomic stems reported a higher incidence of PPF than straight stems. The typical fracture type for anatomical stems is the clamshell pattern, while straight stems are more likely affected by type B fractures.

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Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370:1508–1519. https://doi.org/10.1016/S0140-6736(07)60457-7 CrossRefPubMed

Collis DK (1984) Cemented total hip replacement in patients who are less than fifty years old. J Bone Joint Surg Am 66:353–359CrossRef

Callaghan JJ, Dysart SH, Savory CG (1988) The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series. J Bone Joint Surg Am 70:337–346CrossRef

Abdel MP, Cottino U, Mabry TM (2015) Management of periprosthetic femoral fractures following total hip arthroplasty: a review. Int Orthop 39:2005–2010. https://doi.org/10.1007/s00264-015-2979-0 CrossRefPubMed

Lindahl H, Malchau H, Herberts P, Garellick G (2005) Periprosthetic femoral fractures. J Arthroplast 20:857–865. https://doi.org/10.1016/j.arth.2005.02.001 CrossRef

Schwarzkopf R, Oni JK, Marwin SE (2013) Total hip arthroplasty periprosthetic femoral fractures: a review of classification and current treatment. Bull Hosp Jt Dis (2013) 71:68–78

Kurtz S (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780. https://doi.org/10.2106/JBJS.F.00222 CrossRefPubMed

Abdel MP, Watts CD, Houdek MT et al (2016) Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Joint J 98-B:461–467. https://doi.org/10.1302/0301-620X.98B4.37201 CrossRefPubMed

Lindahl H (2007) Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury 38:651–654. https://doi.org/10.1016/j.injury.2007.02.048 CrossRefPubMed

10.

Sidler-Maier CC, Waddell JP (2015) Incidence and predisposing factors of periprosthetic proximal femoral fractures: a literature review. Int Orthop 39:1673–1682. https://doi.org/10.1007/s00264-015-2721-y CrossRefPubMed

11.

Capello WN, D’Antonio JA, Naughton M (2014) Periprosthetic fractures around a cementless hydroxyapatite-coated implant: a new fracture pattern is described. Clin Orthop Relat Res 472:604–610. https://doi.org/10.1007/s11999-013-3137-x CrossRefPubMed

12.

Lewallen DG, Berry DJ (1998) Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date. Instr Course Lect 47:243–249PubMed

13.

Berry DJ (1999) Epidemiology: hip and knee. Orthop Clin North Am 30:183–190CrossRef

14.

Watts CD, Abdel MP, Lewallen DG et al (2015) Increased risk of periprosthetic femur fractures associated with a unique cementless stem design. Clin Orthop Relat Res 473:2045–2053. https://doi.org/10.1007/s11999-014-4077-9 CrossRefPubMed

15.

Garellick G, Kärrholm J, Lindahl H et al (2016) Substantially higher prevalence of postoperative periprosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem: a prospective cohort study involving 979 hips: (Acta Orthop 2016; 87(3): 257-61). Acta Orthop 87:653–653. https://doi.org/10.1080/17453674.2016.1247561 CrossRefPubMedPubMedCentral

16.

Franklin J, Malchau H (2007) Risk factors for periprosthetic femoral fracture. Injury 38:655–660. https://doi.org/10.1016/j.injury.2007.02.049 CrossRefPubMed

17.

Sarvilinna R, Huhtala H, Pajamäki J (2005) Young age and wedge stem design are risk factors for periprosthetic fracture after arthroplasty due to hip fracture: a case-control study. Acta Orthop 76:56–60. https://doi.org/10.1080/00016470510030328 CrossRefPubMed

18.

Thien TM, Chatziagorou G, Garellick G et al (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:e167–e1–7. https://doi.org/10.2106/JBJS.M.00643 CrossRefPubMed

19.

Brady OH, Garbuz DS, Masri BA, Duncan CP (2000) The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplast 15:59–62CrossRef

20.

Naqvi GA, Baig SA, Awan N (2012) Interobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty. J Arthroplast 27:1047–1050. https://doi.org/10.1016/j.arth.2011.11.021 CrossRef

21.

Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304PubMed

22.

Haidukewych GJ, Langford JR, Liporace FA (2013) Revision for periprosthetic fractures of the hip and knee. Instr Course Lect 62:333–340PubMed

23.

Kaplan EL, Meier P (1958) Nonparametric Estimation from Incomplete Observations. J Am Stat Assoc 53:457–481. https://doi.org/10.1080/01621459.1958.10501452 CrossRef

24.

Herry Y, Viste A, Bothorel H et al (2018) Long-term survivorship of a monoblock long cementless stem in revision total hip arthroplasty. Int Orthop. https://doi.org/10.1007/s00264-018-4186-2 CrossRef

25.

Kim S-M, Han S-B, Rhyu KH et al (2018) Periprosthetic femoral fracture as cause of early revision after short stem hip arthroplasty—a multicentric analysis. Int Orthop 42:2069–2076. https://doi.org/10.1007/s00264-018-3930-y CrossRefPubMed

26.

Cho YJ, Bae CI, Yoon WK et al (2018) High incidence of early subtrochanteric lateral cortical atrophy after hip arthroplasty using bone-conserving short stem. Int Orthop 42:303–309. https://doi.org/10.1007/s00264-017-3544-9 CrossRefPubMed

27.

Schmidt AH, Kyle RF (2002) Periprosthetic fractures of the femur. Orthop Clin North Am 33:143–152 ix CrossRef

28.

Valle Cruz JA, Urda AL, Serrano L et al (2016) Incidence of and risk factors for femoral fractures in the gap between hip and knee implants. Int Orthop 40:1697–1702. https://doi.org/10.1007/s00264-015-2978-1 CrossRefPubMed

29.

Learmonth ID (2004) The management of periprosthetic fractures around the femoral stem. J Bone Joint Surg Br 86:13–19CrossRef

30.

Cook RE, Jenkins PJ, Walmsley PJ et al (2008) Risk factors for periprosthetic fractures of the hip: a survivorship analysis. Clin Orthop Relat Res 466:1652–1656. https://doi.org/10.1007/s11999-008-0289-1 CrossRefPubMedPubMedCentral

31.

Beals RK, Tower SS (1996) Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res:238–246. https://doi.org/10.1097/00003086-199606000-00029 CrossRef

32.

Lindahl H, Garellick G, Regnér H et al (2006) Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg 88:1215–1222. https://doi.org/10.2106/JBJS.E.00457 CrossRefPubMed

33.

Li D, Hu Q, Kang P et al (2018) Reconstructed the bone stock after femoral bone loss in Vancouver B3 periprosthetic femoral fractures using cortical strut allograft and impacted cancellous allograft. Int Orthop 42:2787–2795. https://doi.org/10.1007/s00264-018-3997-5 CrossRefPubMed

Title: Incidence and pattern of periprosthetic hip fractures around the stem in different stem geometry
Authors: Umberto Cottino
Federico Dettoni
Giorgia Caputo
Davide E. Bonasia
Paolo Rossi
Roberto Rossi
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Femoral Fracture
Osteoporosis
Osteoporosis
Hip-TEP
Hip-TEP
Published in: International Orthopaedics / Issue 1/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-019-04336-8

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Springer Medicine

Incidence and pattern of periprosthetic hip fractures around the stem in different stem geometry

Abstract

Background

Patients and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusions

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