title: Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience.
abstract: OBJECTIVE
  The goals of this study were to define the risk factors, nature, chronology, and treatment strategies adopted for periprosthetic femoral fractures in 32 644 primary total hip arthroplasties (THAs).
  
  
  RESULTS
  There were 564 intra-operative fractures (1.7%); 529 during uncemented stem placement (3.0%) and 35 during cemented stem placement (0.23%). Intra-operative fractures were more common in females and patients over 65 years (p < 0.001). The majority occurred during placement of the femoral component (60%), and involved the calcar (69%). There were 557 post-operative fractures (20-year probability: 3.5%; 95% confidence interval (CI) 3.2 to 3.9); 335 fractures after placement of an uncemented stem (20-year probability: 7.7%; 95% CI 6.2 to 9.1) and 222 after placement of a cemented stem (20-year probability: 2.1%; 95% CI 1.8 to 2.5). The probability of a post-operative fracture within 30 days after an uncemented stem was ten times higher than a cemented stem. The most common post-operative fracture type was a Vancouver AG (32%; n = 135), with 67% occurring after a fall. In all, 36% (n = 152) were treated with revision arthroplasty.
  
  
  CONCLUSIONS
  In summary, intra-operative fractures occur 14 times more often with uncemented stems. Female patients over 65 years of age are at highest risk. Post-operative fractures are also most common with uncemented stems, but are independent of age or gender. Cumulative risk of post-operative periprosthetic femur fracture was 3.5% at 20 years.
  
  
  CONCLUSIONS
  Intra-operative fractures occur 14 times more often with uncemented stems, particularly with female patients over 65 years of age, while post-operative fracture risk is independent of age or gender, but still increased with uncemented stems.
authors.affiliation: Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Abdel
authors.affiliation: Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Watts
authors.affiliation: Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Houdek
authors.affiliation: Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Lewallen
authors.affiliation: Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002648:Child; D005260:Female; D005544:Forecasting; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000453:epidemiology* / Q000209:etiology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Periprosthetic fractures; femur; epidemiology; primary total hip arthroplasty; Vancouver classification