Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems: 7,169 total hip arthroplasties from 8 Danish centers
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...
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| Format: | Article |
| Language: | English |
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Medical Journals Sweden
2017-07-01
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| Series: | Acta Orthopaedica |
| Online Access: | http://dx.doi.org/10.1080/17453674.2017.1302908 |
| _version_ | 1828128231907131392 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Martin Lindberg-Larsen |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T16:01:09Z |
| format | Article |
| id | doaj.art-279b0873c9b0498ea2130e2390ca62c0 |
| institution | Directory Open Access Journal |
| issn | 1745-3674 1745-3682 |
| language | English |
| last_indexed | 2024-04-11T16:01:09Z |
| publishDate | 2017-07-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Acta Orthopaedica |
| spelling | doaj.art-279b0873c9b0498ea2130e2390ca62c02022-12-22T04:14:57ZengMedical Journals SwedenActa Orthopaedica1745-36741745-36822017-07-0188439039410.1080/17453674.2017.13029081302908Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems: 7,169 total hip arthroplasties from 8 Danish centersMartin Lindberg-Larsen0Christoffer C Jørgensen1Søren Solgaard2Anne G Kjersgaard3Henrik Kehlet4On behalf of the Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group5Copenhagen University Hospital BispebjergCopenhagen University Hospital RigshospitaletCopenhagen University Hospital GentofteCopenhagen University Hospital GentofteCopenhagen University Hospital RigshospitaletThe Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group consists of: Frank Madsen, Department of Orthopedics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark; Torben B. Hansen, Department of Orthopedics, Regional Hospital Holstebro, Aarhus University, Aarhus, Denmark; Henrik Husted, Orthopedic Department, Hvidovre University Hospital, Copenhagen University, Copenhagen, Denmark; Mogens B. Laursen, Orthopedic Division, Aalborg Hospital, Aalborg University, Aalborg, Denmark; Lars T. Hansen, Orthopedic Department, Sydvestjysk Hospital Esbjerg/Grindsted, Esbjerg, Denmark; Per Kjærsgaard-Andersen, Department of Orthopedics, Vejle Hospital, University of Southern Denmark, Odense, Denmark; and Lars P. Jorn, Orthopedics Department, Viborg Regional Hospital, Viborg, DenmarkBackground 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.http://dx.doi.org/10.1080/17453674.2017.1302908 |
| spellingShingle | 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 Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems: 7,169 total hip arthroplasties from 8 Danish centers Acta Orthopaedica |
| title | Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems: 7,169 total hip arthroplasties from 8 Danish centers |
| title_full | Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems: 7,169 total hip arthroplasties from 8 Danish centers |
| title_fullStr | Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems: 7,169 total hip arthroplasties from 8 Danish centers |
| title_full_unstemmed | Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems: 7,169 total hip arthroplasties from 8 Danish centers |
| title_short | Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems: 7,169 total hip arthroplasties from 8 Danish centers |
| title_sort | increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems 7 169 total hip arthroplasties from 8 danish centers |
| url | http://dx.doi.org/10.1080/17453674.2017.1302908 |
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