title: Primary cementless hip arthroplasty as a potential risk factor for non-union after long-stem revision arthroplasty in periprosthetic femoral fractures.
abstract: OBJECTIVE
  In case of stem loosening in periprosthetic femoral fractures (PPFF), revision arthroplasty should be performed. The first hypothesis of this study was that advanced patient age and female gender shows higher non-union rates. The second hypothesis was that primary cementless arthroplasty is associated with a higher non-union rate compared to cemented primary hip arthroplasty.
  
  
  METHODS
  All PPFF occurring between January 2000 and June 2010 treated by revision arthroplasty were included. Multiple regression analysis was performed to identify independent variables leading to fracture non-union.
  
  
  RESULTS
  Eighty one patients (78 % female) met the inclusion criteria. In 20/81 patients (24.7 %) no adequate fracture healing could be determined on radiographs 12 months after revision surgery. Although age and female gender showed a positive correlation with bony non-union after PPFF as expected, the p-values were not statistically significant. Multiple regression analysis revealed primary cementless prosthesis (p = 0.001) to be the only independent variable associated with non-union.
  
  
  CONCLUSIONS
  Non-cemented primary prosthesis might be a negative predicting factor for the development of non-union after long-stem revision arthroplasty in PPFF. We therefore recommend the thorough debridement of pannus tissue thus inducing bone healing before the implantation of revision prostheses.
authors.affiliation: Department of Trauma, Medical University of Vienna, Vienna, Austria, sandra.boesmueller@meduniwien.ac.at.
authors.forename: Sandra
authors.initials: S
authors.lastname: Boesmueller
authors.forename: Marc
authors.initials: M
authors.lastname: Michel
authors.forename: Marcus
authors.initials: M
authors.lastname: Hofbauer
authors.forename: Patrick
authors.initials: P
authors.lastname: Platzer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000601:surgery*; D011475:Prosthesis Failure / Q000009:adverse effects*; D011859:Radiography; D012044:Regression Analysis; D012086:Reoperation / Q000009:adverse effects*; D012307:Risk Factors