Periprosthetic femoral fractures--evaluation of risk factors

Endoprosthetic hip arthroplasty is a surgical intervention that significantly improves the quality of the patient's life, with excellent long term results, but with an increased risk of major complications. One such complication is the periprosthetic femoral fracture, which may occur in both young and old patients due to several risk factors typical to the elderly (osteoporosis, fall risk), cementless press-fit implants, implant loosening, and revision arthroplasty.

This study tries to evaluate the risk factors for periprosthetic femoral fractures treated at the Orthopedics and Trauma Department of the Iaşi Rehabilitation Hospital. Retrospective evaluations were conducted on 3454 patients with primary hip arthroplasty and 167 patients with revision hip arthroplasty, the surgical procedures being performed between January 1994 and March 2012. The study was conducted on 47 patients (17 males and 30 females, mean age 68 years) with periprosthetic fracture.

The incidence of periprosthetic femoral fractures in primary arthroplasty group was 0.89% (0.63% intraoperative and 0.26% postoperative), with a considerably higher incidence for cementless implants (81.39%), and 9.58% in revision arthroplasty group (8.38% intraoperative and 1.19% postoperative). Vancouver type B was the most frequent, both in operative and postoperative revision arthroplasty and in postoperative primary arthroplasty. 88% of the fractures were surgically treated, with a satisfactory postoperative course both in early and long-term follow-up.

Periprosthetic femoral fractures result in increased morbidity and mortality rate, are difficult to treat, and require complex therapeutic strategies depending on risk factors, fracture type, bone stock, and implant stability.