Higher Rates of Intraoperative Fractures with Compaction Broaching Compared to Conventional Broaching During Hip Hemiarthroplasty for Femoral Neck Fractures

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2024 Jul 15

PMID 39008071

Authors

Nissan Amzallag

Itay Ashkenazi

Shai Factor

Mohamed Abadi

Samuel Morgan

Aviram Gold

Nimrod Snir

Yaniv Warschawski

Affiliations

Soon will be listed here.

Abstract

Purpose: Intraoperative periprosthetic femoral fracture (IPFF) is a known iatrogenic complication during hemiarthroplasty (HA) which may lead to inferior outcomes. The risk factors for IPFF during HA in displaced femoral neck fractures (FNF) remains to be fully elucidated. This study aims to compare IPFF rates between compaction broaching and conventional broaching techniques for cementless HA in FNF.

Methods: We retrospectively reviewed institutional surgical data of patients who underwent cementless HA for displaced FNF from January 2010 to January 2022. Patients were stratified into two groups based on the broaching system: conventional broaching and compaction broaching. The presence, location, and treatment of IPFF were assessed for both groups. Effect of IPFF on postoperative weight-bearing status, mortality readmission and revision rates were compared between groups.

Results: A total of 1,586 patients included in the study. 1252 patients (78.9%) in the conventional broaching group and 334 patients (21.1%) in the compaction broaching group. A total of 104 IPFF were found (6.5%). As compared to conventional broaching, compaction broaching was associated with significant higher IPFF rates (12.9% vs. 4.9%, p < 0.001, OR 2.84, CI 1.88-4.30). The location of the IPFF was similar between groups (p = 0.366), as well as the intraoperative treatment (p = 0.103) and postoperative weight-bearing status (p = 0.640). Surgical time, mortality rates, readmission rates and revision rates were comparable between groups. In a multivariate regression analysis, compaction broaching (OR, 4.24; p < 0.001) was independently associated with IPFF.

Conclusions: This study reveals higher rates of IPFF associated with compaction broaching. Although this finding may have minimal clinical relevance, surgeons should consider these results when considering implant selection.

References

Sathiyakumar V, Greenberg S, Molina C, Thakore R, Obremskey W, Sethi M . Hip fractures are risky business: an analysis of the NSQIP data. Injury. 2014; 46(4):703-8. DOI: 10.1016/j.injury.2014.10.051. View

Bhandari M, Devereaux P, Tornetta 3rd P, Swiontkowski M, Berry D, Haidukewych G . Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005; 87(9):2122-30. DOI: 10.2106/JBJS.E.00535. View

Young P, Patil S, Meek R . Intraoperative femoral fractures: Prevention is better than cure. Bone Joint Res. 2018; 7(1):103-104. PMC: 5805832. DOI: 10.1302/2046-3758.71.BJR-2017-0318.R1. View

Abdel M, Watts C, Houdek M, Lewallen D, Berry D . Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Joint J. 2016; 98-B(4):461-7. DOI: 10.1302/0301-620X.98B4.37201. View

Thillemann T, Pedersen A, Johnsen S, Soballe K . Inferior outcome after intraoperative femoral fracture in total hip arthroplasty: outcome in 519 patients from the Danish Hip Arthroplasty Registry. Acta Orthop. 2008; 79(3):327-34. DOI: 10.1080/17453670710015210. View

Lindberg-Larsen M, Jorgensen C, Solgaard S, Kjersgaard A, Kehlet H . Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems. Acta Orthop. 2017; 88(4):390-394. PMC: 5499329. DOI: 10.1080/17453674.2017.1302908. View

Moroni A, Faldini C, Piras F, Giannini S . Risk factors for intraoperative femoral fractures during total hip replacement. Ann Chir Gynaecol. 2000; 89(2):113-8. View

Sidler-Maier C, Waddell J . Incidence and predisposing factors of periprosthetic proximal femoral fractures: a literature review. Int Orthop. 2015; 39(9):1673-82. DOI: 10.1007/s00264-015-2721-y. View

Sullivan K, Husak L, Altebarmakian M, Brox W . Demographic factors in hip fracture incidence and mortality rates in California, 2000-2011. J Orthop Surg Res. 2016; 11:4. PMC: 4705624. DOI: 10.1186/s13018-015-0332-3. View

10.

Hong C, Nashi N, Tan J, Manohara R, Lee W, Murphy D . Intraoperative periprosthetic femur fracture during bipolar hemiarthroplasty for displaced femoral neck fractures. Arch Orthop Trauma Surg. 2018; 138(9):1189-1198. DOI: 10.1007/s00402-018-2952-7. View

11.

Ashkenazi I, Amzallag N, Factor S, Abadi M, Morgan S, Gold A . Age as a Risk Factor for Intraoperative Periprosthetic Femoral Fractures in Cementless Hip Hemiarthroplasty for Femoral Neck Fractures: A Retrospective Analysis. Clin Orthop Surg. 2024; 16(1):41-48. PMC: 10825253. DOI: 10.4055/cios23157. View

12.

Rogmark C, Leonardsson O . Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J. 2016; 98-B(3):291-7. DOI: 10.1302/0301-620X.98B3.36515. View

13.

Konow T, Baetz J, Melsheimer O, Grimberg A, Morlock M . Factors influencing periprosthetic femoral fracture risk. Bone Joint J. 2021; 103-B(4):650-658. DOI: 10.1302/0301-620X.103B4.BJJ-2020-1046.R2. View

14.

Carli A, Negus J, Haddad F . Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture?. Bone Joint J. 2017; 99-B(1 Supple A):50-59. DOI: 10.1302/0301-620X.99B1.BJJ-2016-0220.R1. View

15.

Mazzawi E, Ghrayeb N, Khury F, Norman D, Keren Y . A comparison between Austin-Moore and Corail prosthesis regarding intraoperative periprosthetic femur fractures in hip hemiarthroplasty. Sci Rep. 2022; 12(1):6340. PMC: 9012879. DOI: 10.1038/s41598-022-10384-9. View

16.

Hjorth M, Stilling M, Soballe K, Nielsen P, Christensen P, Kold S . Preparation of the femoral bone cavity in cementless stems: broaching versus compaction. Acta Orthop. 2016; 87(6):575-582. PMC: 5119439. DOI: 10.1080/17453674.2016.1244958. View

17.

Okowinski M, Hjorth M, Mosegaard S, Jurgens-Lahnstein J, Jakobsen S, Hedevang Christensen P . Ten-year comparison of two different techniques for femoral bone cavity preparation-broaching versus compaction in patients with cementless total hip arthroplasty : a randomized radiostereometric study of 30 total hip arthroplasties in 15 patients.... Bone Jt Open. 2021; 2(12):1035-1042. PMC: 8711659. DOI: 10.1302/2633-1462.212.BJO-2021-0152.R1. View

18.

Vidalain J . Twenty-year results of the cementless Corail stem. Int Orthop. 2010; 35(2):189-94. PMC: 3032112. DOI: 10.1007/s00264-010-1117-2. View

19.

Laflamme M, Angers M, Vachon J, Pomerleau V, Arteau A . High Incidence of Intraoperative Fractures With a Specific Cemented Stem Following Intracapsular Displaced Hip Fracture. J Arthroplasty. 2019; 35(2):485-489. DOI: 10.1016/j.arth.2019.09.017. View

20.

Imam M, Shehata M, Elsehili A, Morsi M, Martin A, Shawqi M . Contemporary cemented versus uncemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: a meta-analysis of forty-two thousand forty-six hips. Int Orthop. 2019; 43(7):1715-1723. DOI: 10.1007/s00264-019-04325-x. View