Functional outcome of femoral peri prosthetic fracture and revision hip arthroplasty: A matched‐pair study from the New Zealand Registry

Abstract

Background and purpose The number of periprosthetic fractures following total hip arthroplasty (THA) is increasing. There is, however, limited data on the functional outcome following these injuries. We analyzed functional outcome for revision THA following periprosthetic fracture, and compared this to the outcome of elective revision THA performed for aseptic loosening.Methods 232 patients undergoing revision THA for femoral fracture were identified from the New Zealand National Registry. Functional outcome was measured using the Oxford 12 hip score (OHS). A reference group of 232 patients undergoing elective revision THA was selected and matched for age and sex.Results Outcome was worse following revision THA for periprosthetic fracture than in reference patients (mean OHS: 29 vs. 24, p = 0.006). A higher 6-month mortality rate was seen in periprosthetic fracture patients (7.3% vs. 0.9%, p < 0.001), along with a higher likelihood of re-revision (7.3% vs. 2.6%, p = 0.06).Interpretation This large comparative series of periprosthetic fractures following THA shows that patients with periprosthetic fracture have poorer functional outcome and higher death rates than patients undergoing revision THA for aseptic loosening.

Does Femoral Component Loosening Predispose to Femoral Fracture?: An In Vitro Comparison of Cemented Hips

“…Fracture treatment is associated with substantial patient risk and cost [15,19,29,31]. We believe the data provide biomechanical justification for previous clinical studies that have advocated more regular monitoring of patients and earlier intervention in situations of femoral component loosening even when patients are relatively asymptomatic.…”

“…Although periprosthetic fracture is a relatively rare complication affecting less than 5% of all hip arthroplasties [3,8,10], it is associated with increased morbidity and mortality compared with aseptic revision surgery [6,14,19,20,31], decreased functional return, and substantial cost to the individual and society. Treatment usually requires open reduction and internal fixation with a wide exposure (wellfixed stem) or a difficult revision arthroplasty (loose stem) with or without allograft struts/bone grafting [16].…”

“…Treatment usually requires open reduction and internal fixation with a wide exposure (wellfixed stem) or a difficult revision arthroplasty (loose stem) with or without allograft struts/bone grafting [16]. Roughly one in five patients treated for periprosthetic fracture has a major complication, a higher mortality rate compared with primary and revision THA, and half have a poor clinical outcome [19,20,28,31]. In 1998, a 78% increase in cost and in increased hospital stay from 6 days to 12 days for treatment of periprosthetic fracture compared with early femoral revision surgery was reported for clinically silent osteolysis [15].…”

Outcomes following surgical treatment of periprosthetic femur fractures: a single centre series

“…In one study, 1-year mortality in patients with periprosthetic fractures is similar to that in patients with hip fractures (11%). 10 In a study from New Zealand, 11 232 patients underwent revision for periprosthetic femur fractures and were compared with a similar group undergoing revision for aseptic loosening. The periprosthetic group had higher mortality and lower functional outcome scores than those in the aseptic loosening group.…”

Intraoperative periprosthetic acetabular fractures during primary total hip arthroplasty: A case report and review of the literature

“…IPPAF management is difficult and usually leads to early failure [6] . Moreover, patients who undergo THA revision because of periprosthetic fracture have poorer functional outcomes and higher death rates than those who undergo THA revision for aseptic loosening [8] .…”