Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hemiarthroplasties

Abstract

Background: Intraoperative periprosthetic fractures (IPF) are a well-described complication following hip hemiarthroplasty. Our aims were to identify risk factors that characterize IPF and to investigate postoperative mobility. Methods: We retrospectively reviewed 481 bipolar hemiarthroplasties for displaced femoral neck fractures; of which, 421 (87.5%) were performed without cement, from January 2013 to March 2018. Data on the patients' demographics, comorbidities, femoral canal geometry (Dorr canal type, Canal Flare Index), surgeon's experience (junior vs. senior surgeon), and timing of surgery (daytime vs. on-call duty) were obtained. In patients with intraoperative fractures, further information was obtained. Patient mobility was assessed using matched-pair analysis. Mobility was classified according to the NHFD mobility score. The chi-square test, Fisher's exact test, and Fisher-Freeman-Halton exact test were used for comparison between categorical variables, while the Mann-Whitney U test was used for continuous variables. The data analysis was performed using SPSS. Results: Of 481 procedures, 34 (7.1%) IPFs were encountered. The Dorr canal type C was identified as a significant risk factor (p = .004). Other risk factors included female sex (OR 2.30, 95% CI .872-6.079), stovepipe femur (OR 1.749, 95% CI .823-3.713), junior surgeon (OR 1.204, 95% CI .596-2.432), and on-call-duty surgery (OR 1.471, 95% CI .711-3.046), although none showed a significant difference. Of 34 IPFs, 25 (73.5%) were classified as Vancouver type A. The treatment of choice was cerclage wiring. Within the 12 matched pairs identified, the postoperative mobility was slightly worse for the IPF group (delta = .41). Conclusions: IPF is a serious complication with bipolar hemiarthroplasty. The identification of risk factors preoperatively, in particular femur shape, is crucial and should be incorporated into the decision-making process.

Risk factors for intraoperative greater trochanteric fractures in hemiarthroplasty for intracapsular femoral neck fractures

“…Our retrospective study found 34 (6.6%) isolated GTFs which is in line with other studies that found GTFs in 4.1–6.3% following HA in patients with a femoral neck fracture [ 12 – 14 ]. The only patient-related risk factor for intraoperative GTF identified in our study was a decreased prothrombin time.…”

“…However, patients in this study presented with mean 25OH-vitamin D3 levels of 20 ng/ml, whereas hip fracture patients in our region exhibit significantly lower levels with a median of 8.4 ng/ml as shown previously [ 17 ]. Hong et al found no difference of T-Scores between groups, but identified Dorr C type femoral canals [ 18 ] as a risk factor for intraoperative fractures as did Bellova et al [ 14 ]. Since we focused on isolated GTF, the Dorr types of the femoral canals were not determined.…”

“…In the fragile group of patients with femoral neck fractures sequelae of GTF might even have more pronounced negative effects. With respect to HA, only limited data are available on intraoperative periprosthetic fractures [12][13][14]. Data analyzing risk factors specifically for intraoperative GTF and their potential effect on outcome are lacking in this group of patients.…”

Proximal Femur Responses to Sequential Therapy With Abaloparatide Followed by Alendronate in Postmenopausal Women With Osteoporosis by 3D Modeling of Hip Dual‐Energy X‐Ray Absorptiometry (DXA)

“…Localized treatment responses within the hip may influence the likelihood of fractures initiating or propagating within the affected subregion, and might also have implications for the fixation of orthopedic implants including hip prostheses. ( 15–17 )…”

“…Localized treatment responses within the hip may influence the likelihood of fractures initiating or propagating within the affected subregion, and might also have implications for the fixation of orthopedic implants including hip prostheses. (15)(16)(17) Cortical and trabecular bone parameters are typically obtained via imaging modalities that rely on 3D quantitative computed tomography (QCT)-based technologies. Such modalities were not included in ACTIVE or ACTIVExtend, but standard two-dimensional (2D) hip dual energy X-ray absorptiometry (DXA) scans can now be processed using 3D-DXA software to model cortical and trabecular measurements, with results that correlate well with QCT results.…”