title: Substantially higher prevalence of postoperative peri-prosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem.
abstract: Background and purpose - Recent studies have demonstrated a high incidence of postoperative periprosthetic femoral fracture (PPF) in elderly patients treated with 2 commonly used cemented, polished tapered stems. We compared the prevalence and incidence rate of PPF in a consecutive cohort of octagenerians with femoral neck fractures (FNFs) treated with either a collarless, polished tapered (CPT) stem or an anatomic matte stem (Lubinus SP2). Patients and methods - In a multicenter, prospective cohort study, we included 979 hips in patients aged 80 years and above (72% females, median age 86 (80-102) years) with a femoral neck fracture as indication for surgery. 69% of the patients were classified as ASA class 3 or 4. Hip-related complications and repeat surgery were assessed at a median follow-up of 20 (0-24) months postoperatively. Results - 22 hips (2.2%) sustained a PPF at a median of 7 (0-22) months postoperatively; 14 (64%) were Vancouver B2 fractures. 7 of the 22 surgically treated fractures required revision surgery, mainly due to deep infection. The cumulative incidence of PPFs was 3.8% in the CPT group, as compared with 0.2% in the SP2 group (p < 0.001). The risk ratio (RR) was 16 (95% CI: 2-120) using the SP2 group as denominator. Interpretation - The CPT stem was associated with a higher risk of PPF than the SP2 stem. We suggest that the tapered CPT stem should not be used for the treatment of femoral neck fractures in patients over 80 years.
authors.affiliation: a Department of Orthopedics, Sundsvall Hospital, Sundsvall, and Department of Surgical and Perioperative Sciences , Umeå University , Umeå ; ;
authors.forename: Sebastian
authors.initials: S
authors.lastname: Mukka
authors.affiliation: a Department of Orthopedics, Sundsvall Hospital, Sundsvall, and Department of Surgical and Perioperative Sciences , Umeå University , Umeå ; ;
authors.forename: Carl
authors.initials: C
authors.lastname: Mellner
authors.affiliation: a Department of Orthopedics, Sundsvall Hospital, Sundsvall, and Department of Surgical and Perioperative Sciences , Umeå University , Umeå ; ;|b Department of Surgical Sciences, Section of Orthopedics , Uppsala University , Uppsala ;
authors.forename: Björn
authors.initials: B
authors.lastname: Knutsson
authors.affiliation: a Department of Orthopedics, Sundsvall Hospital, Sundsvall, and Department of Surgical and Perioperative Sciences , Umeå University , Umeå ; ;
authors.forename: Arkan
authors.initials: A
authors.lastname: Sayed-Noor
authors.affiliation: c Department of Orthopedics, Danderyd Hospital and Karolinska Institutet, Stockholm, and Department of Clinical Sciences , Danderyd Hospital , Stockholm , Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Sköldenberg
mesh_terms: D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D005264:Femoral Fractures / Q000453:epidemiology; D006620:Hip Fractures; D006622:Hip Prosthesis; D006801:Humans; D057068:Periprosthetic Fractures / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011474:Prosthesis Design; D012086:Reoperation; D016896:Treatment Outcome