The incidence of implant fractures after total hip arthroplasty

Abstract

Purpose Implant fractures after total hip arthroplasty (THA) are considered as rare in clinical practice. Nevertheless they are relevant complications for patients, physicians, and the public health system leading to high socioeconomic burdens. The aim of this study was to assess the incidence of fractures after THAs in a comparative analysis of clinical studies and worldwide arthroplasty register datasets. Methods We calculated the pooled incidence of revision operations after fractures of THAs in a comparison of clinical studies published in Medline-listed journals and annual reports of worldwide arthroplasty registers in a structured literature analysis based on a standardised methodology. Results Included clinical studies (sample-based datasets) were mono-centre trials comprising a cumulative number of approximately 70,000 primary implantations whereas worldwide national arthroplasty register datasets referred to 733,000 primary implantations, i.e. approximately ten times as many as samplebased datasets. In general, sample-based datasets presented higher revision rates than register datasets with a maximum deviation of a 14.5 ratio for ceramic heads, respectively. The incidence of implant fractures in total hip arthroplasty in pooled worldwide arthroplasty register datasets is 304 fractures per 100,000 implants. In other words, one out of 323 patients has to undergo revision surgery due to an implant fracture after THA in their lifetime. Conclusions Implant fractures in total hip arthroplasty occur in a relevant number of patients. The authors believe that comprehensive arthroplasty register datasets allow more general evaluations and conclusions on that topic in contrast to clinical studies.

Bisphosphonate Use and Risk of Implant Revision after Total Hip/Knee Arthroplasty: A Meta-Analysis of Observational Studies

“…To date, a variety of causes that contribute to implant failures after TJA have been identified[ 24 – 28 ]. A complication-based analysis using worldwide arthroplasty registers demonstrated that aseptic loosening was the most common cause for revisions both in THA (55.2%) and TKA (29.8%) [ 29 ].…”

The incidence of implant fractures after knee arthroplasty

“…It is likely that implant fractures might be classified as being due to or a result of excessive wear of a [2,3,30] Primary TKA [1,15,34,36] Constrained KA [9,13,28,29,33] particular prosthesis model; the surgeon revising the case then classifies it as a complication due to wear and not due to fracture. This aspect was also covered in a similar way for fractures after total hip arthroplasty and is further discussed in a previous report of our study group [24]. There are several limitations to this study.…”

Keramik-Keramik-Gleitpaarungen in der primären Hüftendoprothetik

“…Bei den Delta-Keramik-Inlays liegt jedoch die Wahrscheinlichkeit eines Bruches noch immer im gleichen Häufigkeitsbereich wie für die Biolox-Gleitpaarung. Hier werden durch Ceramtec 20 Brüche auf 100 000 Versorgungen für das Biolox forte-Inlay angegeben, in Registerdaten liegt die Zahl jedoch etwas höher [40]. Die klinische Relevanz dieser Thematik wird besser verständlich, wenn man in die Betrachtungen einbezieht, dass die Frakturrate der Keramiken deutlich geringer ist als die von Schaftfrakturen, welche zur Revision führen.…”