title: Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems.
abstract: Background and purpose - The use of uncemented fixation in total hip arthroplasty (THA) is increasing. Registry studies have indicated an increased risk of revision of uncemented implants due to early periprosthetic femoral fracture. In this paper, we describe the incidence and predisposing factors for intraoperative and early postoperative (≤ 90 days) periprosthetic femoral fractures after cemented and uncemented THA. Patients and methods - This was a prospective observational study in 8 Danish high-volume centers from February 2010 to November 2013. We used the 90-day follow-up from the Danish National Patient Registry and patient records. We obtained intraoperative information from the Danish Hip Arthroplasty Registry and from surgical notes. Results - Of 7,169 primary consecutive THAs, 5,482 (77%) were performed using uncemented femoral components. The total incidence of periprosthetic femoral fractures ≤ 90 days postoperatively was 2.1% (n = 150). 70 fractures were detected intraoperatively (46 required osteosynthesis). 51 postoperatively detected fractures occurred without trauma (42 of which were reoperated) and 29 were postoperative fall-related fractures (27 of which were reoperated). 134 fractures (2.4%) were found in uncemented femoral components and 16 (0.9%) were found in cemented femoral components (p < 0.001). Uncemented femoral stem (relative risk (RR) = 4.1, 95% CI: 2.3-7.2), medically treated osteoporosis (RR =2.8, CI: 1.6-4.8), female sex (RR =1.6, CI: 1.1-2.2), and age (RR =1.4 per 10 years, CI: 1.2-1.6) were associated with increased risk of periprosthetic femoral fracture when analyzed using multivariable regression analysis. Interpretation - Uncemented femoral components were associated with an increased risk of early periprosthetic femoral fractures, especially in elderly, female, and osteoporotic patients.
authors.affiliation: a Department of Orthopaedic Surgery , Copenhagen University Hospital Bispebjerg , Copenhagen.|b The Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty , Copenhagen University Hospital Rigshospitalet , Copenhagen.
authors.forename: Martin
authors.initials: M
authors.lastname: Lindberg-Larsen
authors.affiliation: b The Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty , Copenhagen University Hospital Rigshospitalet , Copenhagen.|c Section of Surgical Pathophysiology , Copenhagen University Hospital Rigshospitalet , Copenhagen.
authors.forename: Christoffer C
authors.initials: CC
authors.lastname: Jørgensen
authors.affiliation: b The Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty , Copenhagen University Hospital Rigshospitalet , Copenhagen.|d Department of Orthopaedic Surgery , Copenhagen University Hospital Gentofte , Copenhagen.
authors.forename: Søren
authors.initials: S
authors.lastname: Solgaard
authors.affiliation: b The Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty , Copenhagen University Hospital Rigshospitalet , Copenhagen.|d Department of Orthopaedic Surgery , Copenhagen University Hospital Gentofte , Copenhagen.
authors.forename: Anne G
authors.initials: AG
authors.lastname: Kjersgaard
authors.affiliation: b The Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty , Copenhagen University Hospital Rigshospitalet , Copenhagen.|c Section of Surgical Pathophysiology , Copenhagen University Hospital Rigshospitalet , Copenhagen.
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D001843:Bone Cements / Q000627:therapeutic use; D005260:Female; D005264:Femoral Fractures / Q000209:etiology*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D055815:Young Adult
chemical_list: D001843:Bone Cements