title: Revision of primary total hip arthroplasty for peri-prosthetic fracture: A prospective epidemiological study of 249 consecutive cases in France.
abstract: BACKGROUND
  Revision total hip arthroplasty (reTHA) for peri-prosthetic fracture (PPF) is increasingly performed but still ranks fourth among reasons for reTHA in registries. In France, no specific registry is available and the frequency of PPF among reasons for THA revision is therefore unknown. Here, our objectives were to determine the relative frequency of PPF as a reason for reTHA, to identify patient-related and primary-THA-related factors associated with reTHA for PPF, to describe reTHA modalities for PPF, and to determine the morbidity and mortality associated with reTHA for PPF.
  
  
  OBJECTIVE
  PPF is the second most common reason for reTHA, after loosening.
  
  
  METHODS
  Consecutive reTHA procedures performed in 30 French centres over a 2-year period were collected prospectively. Repeat revisions and revisions of hemi-arthroplasties were excluded. The epidemiological, clinical, and surgical data needed to answer the questions of the study were collected.
  
  
  RESULTS
  PPF was the second leading reason for reTHA (249/2107, 11.8%). Vancouver type B2 fractures were the most common (n=127 [51.5%]). Compared to patients who underwent reTHA for reasons other than PPF, those with reTHA for PPF were older at primary THA (67.9 years versus 57.7 years) and more often had intra-operative complications (16.9% versus 11.6%); furthermore, the primary THA was more often cementless (62.7% versus 42.7%) with a dual-mobility cup (20.6% versus 11.1%). At reTHA, the patients with PPF were older (77.6 years versus 69.2 years), had worst medical condition (mean ASA score, 2.4 versus 2.1) and less physically active (mean Devane score, 2.1 versus 2.4). The patients with reTHA for PPF had a shorter time to revision (9.8 years versus 11.4 years), a longer operative time (144 minutes versus 128 minutes), and more frequent use of the posterior approach (77% versus 67%) with a cementless dual-mobility cup (78% versus 60%) and a cementless revision femoral stem (72% versus 50%). Morbidity and mortality rates were high (5.9% operative complication rate and 12% of surgical complications with 4.8% mortality within the first 3 months) however, these results were similar to those in the rest of the cohort.
  
  
  CONCLUSIONS
  PPF is the second most common reason for reTHA, a result that is at variance with data in national registries.
  
  
  METHODS
  Level IV, prospective observational cohort study.
authors.affiliation: Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France. Electronic address: Matthieu.ehlinger@chru-strasbourg.fr.
authors.forename: M
authors.initials: M
authors.lastname: Ehlinger
authors.affiliation: Clinique de l'Yvette, 67-69, route de Corbeil, 91160 Longjumeau, France.
authors.forename: C
authors.initials: C
authors.lastname: Delaunay
authors.affiliation: Service de chirurgie orthopédique, centre hospitalo-universitaire Cochin-Port-Royal, 75014 Paris cedex 14, France.
authors.forename: M
authors.initials: M
authors.lastname: Karoubi
authors.affiliation: Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Bonnomet
authors.affiliation: Unité de biostatistiques, pôle de santé publique, CHRU de Lille, 59037 Lille, France.
authors.forename: N
authors.initials: N
authors.lastname: Ramdane
authors.affiliation: Service de chirurgie orthopédique, centre hospitalo-universitaire Cochin-Port-Royal, 75014 Paris cedex 14, France.
authors.forename: M
authors.initials: M
authors.lastname: Hamadouche
mesh_terms: D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D005260:Female; D005602:France / Q000453:epidemiology; D006304:Health Status; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D057068:Periprosthetic Fractures / Q000145:classification / Q000453:epidemiology* / Q000601:surgery*; D011446:Prospective Studies; D011474:Prosthesis Design; D012086:Reoperation / Q000706:statistics & numerical data
keywords: Orthopaedic registries; Peri-prosthetic fracture; Revision of total hip arthroplasty; Total hip arthroplasty