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Three Hundred and Twenty-one Periprosthetic Femoral Fractures

¹ Department of Orthopaedics, Institute of Surgical Sciences (H.L., G.G., and P.H.), and Department of Radiology (H.R.), Sahlgrenska University Hospital, Göteborg University, SE-413 45 Göteborg, Sweden. E-mail address for H. Lindahl: hans.lindahl{at}vgregion.se
² Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRJ 1126, Boston, MA 02114

Investigation performed at Sahlgrenska University Hospital, Göteborg University, Göteborg, and the Department of Orthopaedics, NU-sjukvården, Uddevalla, Sweden

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Göteborgs Läkaresällskap, Felix Neuberghs stiftelse. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: In the years 1999 and 2000, 321 periprosthetic fractures were reported to the Swedish National Hip Arthroplasty Register. All of the associated hospital records were collected. At the time of follow-up, the Harris hip score, a health-related quality-of-life measure (the EuroQol-5D [EQ-5D] index), and patient satisfaction were used as outcome measurements. A radiologist performed the radiographic evaluation.

Results: Ninety-one patients, with a mean age of 73.8 years, sustained a fracture after one or several revision procedures, and 230 patients, with a mean age of 77.9 years, sustained a fracture after a primary total hip replacement. Minor trauma, including a fall to the floor, and a spontaneous fracture were the main etiologies for the injuries. A high number of patients had a loose stem at the time of the fracture (66% in the primary replacement group and 51% in the revision group). Eighty-eight percent of the fractures were classified as Vancouver type B; however, there was difficulty with preoperative categorization of the fractures radiographically. There was a high failure rate resulting in a low short to mid-term prosthetic survival rate. The sixty-six-month survival rate for the entire fracture group, with reoperation as the end point, was 74.8% ± 5.0%. One factor associated with fracture risk was implant design.

Conclusions: On the basis of these findings, we believe that high-risk patients should have routine radiographic follow-up. Such a routine could identify a loose implant and make intervention possible before a fracture occurred. Furthermore, we recommend an exploration of the joint to test the stability of the implant in patients with a Vancouver type-B fracture in which the stability of the stem is uncertain.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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