title: Prevalence and risk factors for intra-operative periprosthetic fractures in one thousand eight hundred and seventy two patients undergoing total hip arthroplasty: a cross-sectional study.
abstract: OBJECTIVE
  The purpose of this study was to identify the frequency and type of intra-operative periprosthetic fractures and to describe risk factors in a single tertiary, public hospital, so that these events could be prevented, even among less experienced surgeons.
  
  
  METHODS
  This is a cross-sectional study, based on medical records and imaging exams from the archives of a public, tertiary hospital, from April 1998 to October 2013. All consecutive patients submitted to total hip arthroplasty (THA) in the study period were evaluated, excluding unipolar or bipolar arthroplasty, surgery for the osteosynthesis of periprosthetic fractures, surgical procedure to clean infection site without component substitution and not arthroplastic surgery. Data were analyzed with chi-squared test and multivariate Cox regression.
  
  
  RESULTS
  In the study period, 1,872 THA (1,728 patients) were performed and analyzed, with 144 bilateral cases. In 173 cases, patients had undergone surgical procedures other than THA previously, and in only 260 the surgery consisted of revision THA. There were only two cases of resection THA. Among all patients 101 intra-operative periprosthetic fractures occurred. The univariate analysis revealed a significantly higher risk of intra-operative fractures in female patients, aged more than 65 years, with indication of primary THA and the presence of a previous hip surgery. It indicated also that revision surgeries were associated with a 2.8-fold higher risk of intra-operative fracture, 2.18-fold risk in a previously operated hip and 3.9-fold in cases of resection THA or revision surgery in two stages.
  
  
  CONCLUSIONS
  Intraoperative periprosthetic fracture is a rare event, and it is associated with revision type surgery and THA in a previously operated hip.
authors: Hip Clinic, Orthopaedic Department, Santa Casa Medical School and Hospitals, Santa Casa de Misericórdia de São Paulo, R. Dr Cesário Motta Jr, 112, São Paulo, SP, CEP 01221-020, Brazil.
authors: Walter
authors: W
authors: Ricioli
authors: Hip Clinic, Orthopaedic Department, Santa Casa Medical School and Hospitals, Santa Casa de Misericórdia de São Paulo, R. Dr Cesário Motta Jr, 112, São Paulo, SP, CEP 01221-020, Brazil.
authors: Marcelo Cavalheiro
authors: MC
authors: Queiroz
authors: Hip Clinic, Orthopaedic Department, Santa Casa Medical School and Hospitals, Santa Casa de Misericórdia de São Paulo, R. Dr Cesário Motta Jr, 112, São Paulo, SP, CEP 01221-020, Brazil.
authors: Rodrigo Pereira
authors: RP
authors: Guimarães
authors: Hip Clinic, Orthopaedic Department, Santa Casa Medical School and Hospitals, Santa Casa de Misericórdia de São Paulo, R. Dr Cesário Motta Jr, 112, São Paulo, SP, CEP 01221-020, Brazil.
authors: Emerson K
authors: EK
authors: Honda
authors: Hip Clinic, Orthopaedic Department, Santa Casa Medical School and Hospitals, Santa Casa de Misericórdia de São Paulo, R. Dr Cesário Motta Jr, 112, São Paulo, SP, CEP 01221-020, Brazil.
authors: Giancarlo
authors: G
authors: Polesello
authors: Hip Clinic, Orthopaedic Department, Santa Casa Medical School and Hospitals, Santa Casa de Misericórdia de São Paulo, R. Dr Cesário Motta Jr, 112, São Paulo, SP, CEP 01221-020, Brazil. patricia@fucs.com.br.
authors: Patricia M de Moraes Barros
authors: PM
authors: Fucs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001938:Brazil; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D015995:Prevalence; D012086:Reoperation; D012307:Risk Factors; D055815:Young Adult
keywords: Arthroplasty; Hip; Hip fractures; Hip prosthesis; Periprosthetic fractures; Replacement; Risk factors