Late peri-prosthetic femoral fracture as a major mode of failure in uncemented primary hip replacement

Streit, Marcus R.; Merle, Christian; Clarius, Michael; Aldinger, Peter R.

doi:10.1302/0301-620x.93b2.24329

Cited by 53 publications

(36 citation statements)

References 55 publications

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“…Our postoperative fracture incidence of 1.9% also compares favorably with published series of fractures around cementless femoral implants reporting rates of less than 1% to more than 10% [4,[10][11][12][13]15]. We found three patterns of postoperative fractures: pseudo A TL /new B 2 (n = 9), B 1 (n = 9), and C (n = 2).…”

Section: Discussionsupporting

confidence: 83%

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Periprosthetic Fractures Around a Cementless Hydroxyapatite-coated Implant: A New Fracture Pattern Is Described

Capello

DʼAntonio

Naughton

2013

Clin Orthop Relat Res

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Background Periprosthetic fractures can occur both intraoperatively and postoperatively with implantation of cementless tapered stems. Questions/purposes In a large cohort of patients receiving cementless, proximally hydroxyapatite-coated femoral implants, we answered the following questions: What was the incidence of intraoperative and postoperative fractures associated with the implant? What were the fracture patterns as classified by the Vancouver classification system? Did the Vancouver classification represent the fracture patterns found? How were the fractures treated and what were the treatment outcomes; that is, how many fractures healed and did the stems osseointegrate? Methods We evaluated 1039 hips (932 patients) from three prospective studies. The hips were divided into three groups: no fractures, intraoperative fractures, and postoperative fractures. Demographic differences among the groups were noted. Postoperative fractures were classified using the Vancouver classification system. We judged stem stability using Engh's criteria and fracture union was determined by the treating surgeon and confirmed by the authors. Results We identified 58 periprosthetic fractures in the 1039 hips (5.6%): 38 intraoperative (3.7%) and 20 postoperative (1.9%). Eleven of the postoperative fractures were classifiable by the original Vancouver classification system and nine were of the newly described ''clamshell'' variety, not classifiable by this system. No intraoperative fractures extended below the lesser trochanter. Twenty-five of these fractures were treated with a single cable or cerclage wire. The remaining received no specific treatment. Of the 20 postoperative fractures, five were treated nonoperatively. All stems osseointegrated. Conclusions Both intraoperative and postoperative fractures can be managed with success when the stem is

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Section: Discussionsupporting

confidence: 83%

“…The reported frequency of fracture around cementless proximally fixed stems is between 0.4% and 11%, and for the most part, those data derive from small studies (100-436 patients) [4,[10][11][12][13]15]. The much larger national registries focus on primarily cemented femoral implants, reporting fracture frequencies of 0.4% to 2.5% [2,8].…”

Section: Introductionmentioning

confidence: 99%

Periprosthetic Fractures Around a Cementless Hydroxyapatite-coated Implant: A New Fracture Pattern Is Described

Capello

DʼAntonio

Naughton

2013

Clin Orthop Relat Res

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“…In a recently reported series, a considerably higher stem survival rate was found at 12 years when this stem was combined with a second-generation acetabular component [51]. As reported previously [50], late periprosthetic femoral fracture after minor trauma (eg, falls from ground level) was an important mode of failure in this series resulting in increasing rates of revision in the second and third decades after surgery. Periprosthetic femoral fractures have been reported as an important reason for failure in the long term with use of other uncemented [35] and cemented stem designs [12].…”

Section: Discussionsupporting

confidence: 66%

Long-term (20- to 25-year) Results of an Uncemented Tapered Titanium Femoral Component and Factors Affecting Survivorship

Streit¹,

Innmann²,

Merle³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Uncemented femoral components in primary total hip arthroplasty (THA) are commonly used today, but few studies have evaluated their survival into the third decade. Questions/purposes We evaluated (1) survivorship using femoral revision for any reason as the end point; (2) survivorship using femoral revision for aseptic loosening as the end point; and (3) patient-related and surgical risk factors for aseptic stem loosening at a minimum 20-year followup with an uncemented tapered titanium stem.Methods We reviewed the clinical and radiographic results of 354 THAs in 326 patients performed between January 1985 and December 1989 using an uncemented grit-blasted, tapered titanium femoral stem. Mean age at surgery was 57 years (range, 13-81 years). Kaplan-Meier survivorship analysis was used to estimate long-term survival. Minimum followup evaluation was 20 years (mean, 22 years; range, 20-25 years); at that time, 120 patients (127 hips) had died, and four patients (five hips) were lost to followup. Multivariate survival analysis using a Cox regression model was performed. Results Survivorship at 22 years with revision of the femoral component for any reason as the end point was 86% (95% confidence interval [CI], 81%-90%). Survivorship for femoral revision for aseptic loosening as the end point was 93% at 22 years (95% CI, 90%-96%). Undersized stems (canal fill index B 80%) and stems in hips with cup revision were at higher risk for aseptic loosening (hazard ratio, 4.2 and 4.3, respectively). There was a high rate of acetabular revision in this series (38%), mostly related to smooth-threaded, cementless sockets. Conclusions Uncemented femoral fixation was reliable into the third decade. Age, male sex, and diagnosis were not associated with a higher risk of aseptic loosening.

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“…It is evidently an important design feature that might reduce the incidence of late periprosthetic fractures and/or trochanteric avulsions (Lindahl 2007, Streit et al 2011). …”

Section: Discussionmentioning

confidence: 99%

“…Periprosthetic bone loss in uncemented femoral stems can contribute to late-occurring periprosthetic fractures (Lindahl 2007, Streit et al 2011). This is partly mediated by adaptive bone resorption.…”

mentioning

confidence: 99%

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Salemyr¹,

Muren²,

Ahl³

et al. 2015

Acta Orthopaedica

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Background and purpose — We hypothesized that an ultra-short stem would load the proximal femur in a more physiological way and could therefore reduce the adaptive periprosthetic bone loss known as stress shielding.Patients and methods — 51 patients with primary hip osteoarthritis were randomized to total hip arthroplasty (THA) with either an ultra-short stem or a conventional tapered stem. The primary endpoint was change in periprosthetic bone mineral density (BMD), measured with dual-energy x-ray absorptiometry (DXA), in Gruen zones 1 and 7, two years after surgery. Secondary endpoints were change in periprosthetic BMD in the entire periprosthetic region, i.e. Gruen zones 1 through 7, stem migration measured with radiostereometric analysis (RSA), and function measured with self-administered functional scores.Results — The periprosthetic decrease in BMD was statistically significantly lower with the ultra-short stem. In Gruen zone 1, the mean difference was 18% (95% CI: −27% to −10%). In zone 7, the difference was 5% (CI: −12% to −3%) and for Gruen zones 1–7 the difference was also 5% (CI: −9% to −2%). During the first 6 weeks postoperatively, the ultra-short stems migrated 0.77 mm more on average than the conventional stems. 3 months after surgery, no further migration was seen. The functional scores improved during the study and were similar in the 2 groups.Interpretation — Up to 2 years after total hip arthroplasty, compared to the conventional tapered stem the ultra-short uncemented anatomical stem induced lower periprosthetic bone loss and had equally excellent stem fixation and clinical outcome.

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Late peri-prosthetic femoral fracture as a major mode of failure in uncemented primary hip replacement

Cited by 53 publications

References 55 publications

Periprosthetic Fractures Around a Cementless Hydroxyapatite-coated Implant: A New Fracture Pattern Is Described

Periprosthetic Fractures Around a Cementless Hydroxyapatite-coated Implant: A New Fracture Pattern Is Described

Long-term (20- to 25-year) Results of an Uncemented Tapered Titanium Femoral Component and Factors Affecting Survivorship

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

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