High risk of early periprosthetic fractures after primary hip arthroplasty in elderly patients using a cemented, tapered, polished stem

Abstract

Background and purpose Postoperative periprosthetic femoral fracture (PPF) after hip arthroplasty is associated with considerable morbidity and mortality. We assessed the incidence and characteristics of periprosthetic fractures in a consecutive cohort of elderly patients treated with a cemented, collarless, polished and tapered femoral stem (CPT).Patients and methods In this single-center prospective cohort study, we included 1,403 hips in 1,357 patients (mean age 82 (range 52–102) years, 72% women) with primary osteoarthritis (OA) or a femoral neck fracture (FNF) as indication for surgery (367 hips and 1,036 hips, respectively). 64% of patients were ASA class 3 or 4. Hip-related complications and need for repeat surgery were assessed at a mean follow-up time of 4 (1–7) years. A Cox regression analysis was used to evaluate risk factors associated with PPF.Results 47 hips (3.3%) sustained a periprosthetic fracture at median 7 (2–79) months postoperatively; 41 were comminute Vancouver B2 or complex C-type fractures. The fracture rate was 3.8% for FNF patients and 2.2% for OA patients (hazard ratio (HR) = 4; 95% CI: 1.3–12). Patients > 80 years of age also had a higher risk of fracture (HR = 2; 95% CI: 1.1–4.5).Interpretation We found a high incidence of early PPF associated with the CPT stem in this old and frail patient group. A possible explanation may be that the polished tapered stem acts as a wedge, splitting the femur after a direct hip contusion. Our results should be confirmed in larger, registry-based studies, but we advise caution when using this stem for this particular patient group.

Radiologic outcomes of open reduction and internal fixation for cementless stems in Vancouver B2 periprosthetic fractures

“…It is generally recommended that Vancouver B2 fractures should be treated with a long femoral stem revision to restore stability of the femoral prosthesis and to obtain sufficient intramedullary fixation of the fractures. This strategy permits early weight bearing and therefore improved mobility compared with treatment with osteosynthesis and protected weight bearing 1, 18, 23, 24, 25. However, no single surgical recommendation has gained universal acceptance.…”

More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures

“…6) (116). 24 Small observational studies including both HAs and THAs (117)(118)(119) and one large register study on THAs (120) Patients treated with HA for FNF represent an older and more comorbid population with more osteoporotic bone structure than THA patients (10), and the risk of PPF could therefore potentially be higher than for THA patients.…”

Increased risk for postoperative periprosthetic fracture in hip fracture patients with the Exeter stem than the anatomic SP2 Lubinus stem

“…PPF is a severe complication and the surgical treatment of PPF is often challenging due to revision surgery and an increased risk for postoperative readmission due to surgical complications [18,19]. Osteopenia, hip fracture as an indication for primary surgery, age greater than 80 years and the use of polished tapered femoral stems have all been associated with an increased incidence of PPF and a predisposition for Vancouver B2 PPFs [10,[20][21][22]. In a previous study from our institution, we found that the polished, tapered CPT stem was associated with a high incidence of early PPF in an FNF population more than 80 years of age [15].…”

“…Extensive revision surgery contributes to a high mortality rate and, in those who prevail, makes recovery difficult [5,6]. Several risk factors for PPF have been proposed, including advanced age, sex [7,8], osteoporosis, rheumatoid arthritis [9], and femoral neck fracture (FNF) as an indication for primary surgery [10]. The treatment of PPF can be technically demanding and is plagued with a high frequency of complications due to deep infection, dislocation, and intraoperative fractures [11,12].…”

“…The two most commonly used cemented implants in Sweden for treating a displaced FNF are the polished, tapered Exeter stem and the matte, anatomic Lubinus SP2 stem [13]. Recent reports have identified a high incidence of PPF associated with the Exeter and the similarly tapered (CPT, Zimmer, Inc., Warsaw, IN, USA) stems in elderly FNF patients [10,[14][15][16]. There are few cohort studies comparing the Exeter and Lubinus femoral stems regarding the risk for PPF in patients with hip fractures.…”