High complication rates found in operative treatment of periprosthetic femur fractures

Operative treatment of periprosthetic femur fractures sustained in the postoperative period following primary total hip arthroplasty had a high rate of complication while secondary operative procedures had a high risk of infection and heterotopic ossification, according to this study from researchers at Rush University Medical Center.

Researchers retrospectively reviewed 5,313 primary total hip arthroplasties performed during a 10-year period. They evaluated risk factors for results of operatively treated periprosthetic femoral fracture sustained within 90 days of total hip arthroplasty in 0.60% of patients with A_G, B₁, B₂, B₃ and A_G/B₂ fractures.

Study results showed that 61% of patients had 23 complications, including 9 greater trochanter non-unions, 2 femoral shaft non-unions, 3 patients with Brooker III heterotopic ossification and 2 deep infections. Injuries included low energy falls (41%), a high-energy injury (3%) or association with a dislocation (3%). Thirty-one percent of patients had no history of trauma and 22% had fractures found on a routine radiograph during the early postoperative period without symptoms. Only 23% required a second operative procedure and one patient required a third procedure. Advancing age, female gender, developmental hip dysplasia and cementless metaphyseal engaging components, particularly flat wedge tapers, were associated with periprosthetic fractures.

Disclosure: Some researchers receive royalties from Zimmer; are a paid consultant for Biomet, Convatec, Salient Surgical and Smith & Nephew; receive research support from Smith & Nephew and Stryker; receive royalties from SLACK Incorporated; and are board members for the American Association of Hip and Knee Surgeons and The Knee Society.

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Source: Sheth NP. J Arthropl. 2012;doi:10.1016/j.arth.2012.06.003.