Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems

Autor:	Martin Lindberg-Larsen, Christoffer C Jørgensen, Søren Solgaard, Anne G Kjersgaard, Henrik Kehlet, On behalf of the Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group
Rok vydání:	2017
Předmět:	Orthopedic surgery 030222 orthopedics medicine.medical_specialty Osteosynthesis business.industry medicine.medical_treatment Osteoporosis Periprosthetic General Medicine Femoral fracture medicine.disease Arthroplasty Surgery 03 medical and health sciences 0302 clinical medicine Relative risk medicine Orthopedics and Sports Medicine 030212 general & internal medicine Radiology Intraoperative Period business Prospective cohort study RD701-811
Zdroj:	Acta Orthopaedica, Vol 88, Iss 4, Pp 390-394 (2017)
ISSN:	1745-3682 1745-3674
DOI:	10.1080/17453674.2017.1302908
Popis:	Background and purpose — The use of uncemented fixation in total hip arthroplasty (THA) is increasing. Registry studies have indicated an increased risk of revision of uncemented implants due to early periprosthetic femoral fracture. In this paper, we describe the incidence and predisposing factors for intraoperative and early postoperative (≤ 90 days) periprosthetic femoral fractures after cemented and uncemented THA. Patients and methods — This was a prospective observational study in 8 Danish high-volume centers from February 2010 to November 2013. We used the 90-day follow-up from the Danish National Patient Registry and patient records. We obtained intraoperative information from the Danish Hip Arthroplasty Registry and from surgical notes. Results — Of 7,169 primary consecutive THAs, 5,482 (77%) were performed using uncemented femoral components. The total incidence of periprosthetic femoral fractures ≤ 90 days postoperatively was 2.1% (n = 150). 70 fractures were detected intraoperatively (46 required osteosynthesis). 51 postoperatively detected fractures occurred without trauma (42 of which were reoperated) and 29 were postoperative fall-related fractures (27 of which were reoperated). 134 fractures (2.4%) were found in uncemented femoral components and 16 (0.9%) were found in cemented femoral components (p < 0.001). Uncemented femoral stem (relative risk (RR) = 4.1, 95% CI: 2.3–7.2), medically treated osteoporosis (RR =2.8, CI: 1.6–4.8), female sex (RR =1.6, CI: 1.1–2.2), and age (RR =1.4 per 10 years, CI: 1.2–1.6) were associated with increased risk of periprosthetic femoral fracture when analyzed using multivariable regression analysis. Interpretation — Uncemented femoral components were associated with an increased risk of early periprosthetic femoral fractures, especially in elderly, female, and osteoporotic patients.
Databáze:	OpenAIRE
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