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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 1/2024

24-08-2023 | Periprosthetic Fracture | Hip Arthroplasty

Periprosthetic fracture following anterior approach or dislocation after posterior approach: which one is the lesser evil?

Authors: Jeroen C. F. Verhaegen, Tom Schmidt-Braekling, Roger Wei, Paul E. Beaulé, George Grammatopoulos, Ottawa Arthroplasty Group

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2024

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Abstract

Introduction

The most common approaches in total hip arthroplasty (THA) have different complication profiles; anterior-approach (AA-THA) has an increased risk of periprosthetic fractures (PPF); posterior-approach (PA-THA) is associated with higher dislocation risk. However, the relative severity of one versus the other is unknown. This study aims to compare outcome of patients who suffered PPF after AA-THA with those that sustained dislocation after PA-THA.

Methods

This is a retrospective, single-center, multi-surgeon, consecutive case-series of primary THA patients. In a cohort of 9867 patients who underwent THA, 79 fulfilled the approach-specific, post-operative complication criteria, of which 44 were PPF after AA-THA and 35 with dislocation after PA-THA (age 67.9 years (range: 38.0–88.1), 58.2% women). Outcome included complication- and revision- rates, and patient-reported outcomes including Oxford Hip Score (OHS).

Results

At 5.8 years follow-up (range: 2.0–18.5), reoperation was more common in the dislocation after PA-THA group (23/35 vs. 20/44; p = 0.072). Change of surgical approach occurred in 15/20 of patients with PPF after AA-THA, but none in those with dislocation after PA-THA. Following re-operation, complication rate was greater in the PPF group (9/20 vs. 4/23; p = 0.049). At latest follow-up, OHS were superior in the PPF after AA-THA group [42.6 (range: 25.0–48.0) vs. 36.6 (range: 21.0–47.0); p = 0.006].

Conclusion

Dislocation following PA-THA is more likely to require revision. However, PPF following AA-THA requires more often a different surgical approach and is at higher risk of complications. Despite the increased surgical burden post-operative PROMs are better in the peri-prosthetic fracture group, especially in cases not requiring reoperation.

Level of evidence

III, case–control study
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Metadata
Title
Periprosthetic fracture following anterior approach or dislocation after posterior approach: which one is the lesser evil?
Authors
Jeroen C. F. Verhaegen
Tom Schmidt-Braekling
Roger Wei
Paul E. Beaulé
George Grammatopoulos
Ottawa Arthroplasty Group
Publication date
24-08-2023
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 1/2024
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-023-05034-2

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