Periprosthetic fractures of the proximal femur within first year of the index hip prosthesis

Main Article Content

Mauro Spina https://orcid.org/0000-0003-0079-021X
Andrea Scalvi

Keywords

periprosthetic hip fracture, oversize uncemented stem, Stem Size Index, osteoporosis, neuropsychiatric disease

Abstract

Introduction: Periprosthetic fractures are a serious complication of implants prosthetic. The aim of this review is to analyze incidence and predisposing factors of periprosthetic fractures of the proximal femur within first year of the index hip prosthesis. Materials and methods: Between 1998 and 2017 we have performed 4240 hip replacements (F 2661, M 1579): 2877 total hip arthroplasties (67,9%) and 1363 hemiartrhoplasties (32,1%). Hip replacements with cemented stem were 2173 (51,2%), while cementless ones were 2067 (48,8%). In the same period we admitted 121 hip periprosthetic fractures, 26 of which (0,6%) within the first year of the index surgery. We examined the medical and radiographic records of this last cohort of patients (F 19, M 7) following the Vancouver System, Dorr Classification and Stem Size Index. Results: The cause was a low-energy trauma in 25 cases (96.1%); the primary diagnosis was hip fracture in 20 patients (76.9%); 8 patients were taking chronic osteoporosis medication (30.7%); 14 patients were affected by neuropsychiatric disease (53.8%); cementless stems were found in 18 cases, 12 of which were oversized (SSI < 0,8). According to Vancouver System, fractures were classified as follows: 10 type B1, 14 type B2 and 2 type C. As far as the proximal femoral shape, 2 cases were Dorr type A, 7 Dorr type B and 17 Dorr type C. Conclusions: The incidence of periprosthetic fractures in the aftermath of stem implant is twice as high with uncemented stems. The Vancouver type B1/B2 is the most common. Predisposing factors are: female sex, hip fracture, chronic osteoporosis medication, neuropsychiatric disease and oversized uncemented stem (SSI < 0.8).The evidence level is IV.

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References

1. Melvin JS, Karthikeyan T, Cope R, Fehring TK. Early failures in total hip arthroplasty – a changing paradigm. J Arthroplasty. 2014 ; 29(6):1285-8.
2. Sidler-Maier CC, Waddell JP. Incidence and predisposing factors of periprosthetic proximal femoral fractures: a literature review. International Orthopaedics. 2015 ; 39(9):1673-82.
3. Zhang T, Zheng C, Ma H, Sun C. Causes of early failure after total hip arthroplasty. Zhonghua Yi Xue Za Zhi. 2014 ; 94(48):3836-8.
4. Young SW, Walker CG, Pitto RP. Functional outcome of femoral periprosthetic fracture and revision hip arthroplasty: a matched-pair study from the New Zealand Registry. Acta Orthop. 2008 ; 79(4):483-488.
5. Bhattacharyya T, Chang D, Meigs JB, Estok DM 2nd, Malchau H. Mortality after periprosthetic fracture of the femur. J Bone Joint Surg (Am). 2007 ; 89(12):2658-62.
6. Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone. 1993 ; 14(3):231-42.
7. Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007 ; 38(6):651-654.
8. Brodner W, Bitzan P, Lomoschitz F, Krepler P, Jankovsky R, Lehr S, et al. Changes in bone mineral density in the proximal femur after cementless total hip arthroplasty. A five-year longitudinal study. J Bone Joint Surg Br. 2004 ;86(1):20-6.
9. Beals RK, Tower SS. Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res. 1996 ;(327):238-46.
10. Iesaka K, Kummer FJ, Di Cesare PE. Stress risers between two ipsilateral intramedullary stems: a finite-element and biomechanical analysis. J Arthroplasty. 2005 ;20(3):386-91.
11. Fleischman AN, Chen AF. Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls. Ann Transl Med. 2015 ;3(16):234.
12. Yoon BH, Lee YK, Jo WL, Ha YC, Choi DH, Koo KH. Incidence and Risck period of periprosthetic femoral fracture after cementless bipolar hemiarthroplasty in elderly patients. J Arthroplasty. 2016 ; 31(6):1326-30.
13. Taunton MJ, Dorr LD, Long WT, Dastane MR, Berry DJ. Early postoperative femur fracture after uncemented collarless primary total hip arthroplasty: characterization and results of treatment. J Arthroplasty. 2015 ; 30(11):2008-11.
14. Lachiewicz PF. Cement fixation of the femoral component in older patients. Instr Course Lect. 2008; 57:261-5
15. Yeung Y, Chiu KY, Yau WP, Tang WM, Cheung WY, Ng TP. Assessment of the Proximal Femoral Morphology using Plain Radiograph – Can it predict the bone quality? J Arthroplasty. 2006 ; 21(4):508-13.
16. 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(7):857-65.
17. Haddad FS, Masri BA, Garbuz DS, Duncan CP. The prevention of periprosthetic fractures in total hip and knee arthroplasty. Orthop Clin North Am. 1999 ; 30(2):191-207.
18. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005 ; 90(3):1294-1301.
19. Woo SB, Choi ST, Chan WL. Atypical periprosthetic femoral fracture: a case report. J Orthop Surg. 2016 ; 24(2):269-72.
20. Franklin J, Malchau H. Risk factors for periprosthetic femoral fracture. Injury. 2007 ;38(6):655-60.
21. Thien TM, Chatziagorou G, Garellick G, Furnes O, Havelin LI, Mäkelä K, et al. 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. 2014 ; 96(19):e167.
22. Meek R, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Am. 2011; 93:96–101.
23. Singh JA, Jensen MR, Harmsen SW, Lewallen DG. Are gender, comorbidity, and obesity risk factors for postoperative periprosthetic fractures after primary total hip arthroplasty? J Arthroplasty. 2013; 28:126–131.
24. Berend ME, Smith A, Meding JB, Ritter MA, Lynch T, Davis K. Long-term outcome and risk factors of proximal femoral fracture in uncemented and cemented total hip arthroplasty in 2551 hips. J Arthroplasty. 2006; 21:53–59.
25. Sarvilinna R, Huhtala H, Sovelius, Halonen PJ, Nevalainen JK, Pajamäki KJ. Factors predisposing to periprosthetic fracture after hip arthroplasty: A case (n = 31)-control study. Acta Orthop Scand. 2004; 75:16–20.
26. Cook R, Jenkins P, Walmsley P, Patton JT, Robinson CM. Risk factors for periprosthetic fractures of the hip: A survivorship analysis. Clin Orthop Relat Res. 2008; 466:1652–1656.
27. Sarvilinna R, Huhtala H, Pajamäki J. Young age and wedge stem design are risk factors for periprosthetic fracture after arthroplasty due to hip fracture: A case-control study. Acta Orthop. 2005; 76:56–60.
28. Zhang C. Analysis on relevant factors of around prosthesis fracture after total replacement. Mod Prev Med. 2012; 39:3961–3963.
29. Wu CC, Au MK, Wu SS, Lin LC. Risk factors for postoperative femoral fracture in cementless hip arthroplasty. J Formos Med Assoc. 1999 Mar; 98(3):190-4.