Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems

Martin Lindberg-Larsen, Lunbeck Foundation Centre for Fast-track Hip and Knee Replacement

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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.

OriginalsprogEngelsk
TidsskriftActa Orthopaedica (Print Edition)
Vol/bind88
Udgave nummer4
Sider (fra-til)390-394
ISSN1745-3674
DOI
StatusUdgivet - aug. 2017
Udgivet eksterntJa

Fingeraftryk

Femoral Fractures
Registries
Hip
Incidence
Causality
Regression Analysis
Prospective Studies
Wounds and Injuries

Citer dette

Lindberg-Larsen, Martin ; Lunbeck Foundation Centre for Fast-track Hip and Knee Replacement. / Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems. I: Acta Orthopaedica (Print Edition). 2017 ; Bind 88, Nr. 4. s. 390-394.
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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.",
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author = "Martin Lindberg-Larsen and J{\o}rgensen, {Christoffer C} and S{\o}ren Solgaard and Kjersgaard, {Anne G} and Henrik Kehlet and {Lunbeck Foundation Centre for Fast-track Hip and Knee Replacement}",
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Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems. / Lindberg-Larsen, Martin; Lunbeck Foundation Centre for Fast-track Hip and Knee Replacement.

I: Acta Orthopaedica (Print Edition), Bind 88, Nr. 4, 08.2017, s. 390-394.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems

AU - Lindberg-Larsen, Martin

AU - Jørgensen, Christoffer C

AU - Solgaard, Søren

AU - Kjersgaard, Anne G

AU - Kehlet, Henrik

AU - Lunbeck Foundation Centre for Fast-track Hip and Knee Replacement

PY - 2017/8

Y1 - 2017/8

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Arthroplasty, Replacement, Hip/adverse effects

KW - Bone Cements/therapeutic use

KW - Female

KW - Femoral Fractures/etiology

KW - Hip Prosthesis/adverse effects

KW - Humans

KW - Intraoperative Period

KW - Male

KW - Middle Aged

KW - Postoperative Complications/etiology

KW - Prospective Studies

KW - Registries

KW - Risk Factors

KW - Young Adult

U2 - 10.1080/17453674.2017.1302908

DO - 10.1080/17453674.2017.1302908

M3 - Journal article

VL - 88

SP - 390

EP - 394

JO - Acta Orthopaedica (Print Edition)

JF - Acta Orthopaedica (Print Edition)

SN - 1745-3674

IS - 4

ER -