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Intraoperative THA femoral fractures increase revision risk up to 6 months postop

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SAN FRANCISCO — Femoral fractures that occur intraoperatively during primary total hip arthroplasty and that are treated with osteosynthesis increase the risk of revision up to 6 months after surgery, according to a study presented here.

However, implant survival does not appear to be affected after 6 months, the study authors noted.

Theis M. Thillemann, MD, and colleagues at Aarhus University Hospital in Denmark reviewed data from the Danish Hip Arthroplasty Register to identify patients who underwent primary total hip arthroplasty for osteoarthritis between 1995 and 2005. They then calculated implant survival and relative risk estimates for patients who sustained intraoperative femoral fractures treated either conservatively or with osteosynthesis. These patients were compared to a reference group of THA patients who did not sustain intraoperative fractures, according to the study.

Thillmann and colleagues displayed their results in a poster at the American Academy of Orthopaedic Surgeons 75th Annual Meeting.

The study found that 357 revisions were performed by 6 months after surgery among 38,952 primary THAs included in the reference group.

Among the 282 THAs included in the conservative treatment group, four revisions were performed, yielding a relative risk of 1.49. However, surgeons performed 13 revisions by 6 months postop among 237 THAs included in the osteosynthesis group, for a relative risk of 5.72, according to the study.

After 6 months postop, both fracture groups had 10 revisions each, yielding a relative risk of 1.08 for the conservative treatment group and of 1.54 for the osteosynthesis group.

"Adjusted [relative risk] for revision due to dislocation in [the] osteosynthesis group [equaled] 7.2. Otherwise, no significant differences in indication for revision between groups was found," the authors said in the study.

For more information:

• Thillemann TM, Pedersen AB, Johnsen SP, Søballe K. Prognosis after sustaining intraoperative femoral fracture during primary total hip arthroplasty. P099. Presented at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.