High Risk of Early Periprosthetic Fractures After Primary Hip Arthroplasty in Elderly Patients Using a Cemented, Tapered, Polished Stem

Overview

Journal Acta Orthop

Specialty Orthopedics

Date 2014 Oct 4

PMID 25280133

Citations 33

Authors

Cyrus Broden

Sebastian Mukka

Olle Muren

Thomas Eisler

Henrik Boden

Andre Stark

Olof Skoldenberg

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Postoperative periprosthetic femoral fracture (PPF) after hip arthroplasty is associated with considerable morbidity and mortality. We assessed the incidence and characteristics of periprosthetic fractures in a consecutive cohort of elderly patients treated with a cemented, collarless, polished and tapered femoral stem (CPT).

Patients And Methods: In this single-center prospective cohort study, we included 1,403 hips in 1,357 patients (mean age 82 (range 52-102) years, 72% women) with primary osteoarthritis (OA) or a femoral neck fracture (FNF) as indication for surgery (367 hips and 1,036 hips, respectively). 64% of patients were ASA class 3 or 4. Hip-related complications and need for repeat surgery were assessed at a mean follow-up time of 4 (1-7) years. A Cox regression analysis was used to evaluate risk factors associated with PPF.

Results: 47 hips (3.3%) sustained a periprosthetic fracture at median 7 (2-79) months postoperatively; 41 were comminute Vancouver B2 or complex C-type fractures. The fracture rate was 3.8% for FNF patients and 2.2% for OA patients (hazard ratio (HR) = 4; 95% CI: 1.3-12). Patients > 80 years of age also had a higher risk of fracture (HR = 2; 95% CI: 1.1-4.5).

Interpretation: We found a high incidence of early PPF associated with the CPT stem in this old and frail patient group. A possible explanation may be that the polished tapered stem acts as a wedge, splitting the femur after a direct hip contusion. Our results should be confirmed in larger, registry-based studies, but we advise caution when using this stem for this particular patient group.

Citing Articles

Open reduction and internal fixation offers lower hip-related complications compared to stem revision in Vancouver B2 fractures around cemented polished tapered femoral stems.

Skoldenberg O, Mukka S, Axenhus M, Hedbeck C, Magneli M J Exp Orthop. 2025; 12(1):e70179.

PMID: 39957836 PMC: 11826054. DOI: 10.1002/jeo2.70179.

Evidence for cemented TKA and THA based on a comparison of international register data.

Humez M, Kotter K, Skripitz R, Kuhn K Orthopadie (Heidelb). 2024; 53(8):597-607.

PMID: 38568216 PMC: 11329679. DOI: 10.1007/s00132-024-04489-4.

Experience of an anatomic femoral stem in a UK orthopaedic centre beyond 20 years of follow-up.

Turnbull G, Blacklock C, Akhtar A, Dunstan E, Ballantyne J Eur J Orthop Surg Traumatol. 2024; 34(4):2155-2162.

PMID: 38565783 PMC: 11101503. DOI: 10.1007/s00590-024-03901-1.

Evaluation of Clinical and Radiological Outcomes in the Management of Intracapsular Fracture Neck of Femur in Elderly Treated With Cemented Bipolar Prosthesis.

Lucas A, Faizal A Cureus. 2024; 16(2):e55283.

PMID: 38562269 PMC: 10983056. DOI: 10.7759/cureus.55283.

[Register data on cemented arthroplasty : A proof for cementless fixation?].

Humez M, Kotter K, Skripitz R, Kuhn K Orthopadie (Heidelb). 2023; 53(3):163-175.

PMID: 37889315 PMC: 10896946. DOI: 10.1007/s00132-023-04451-w.

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