A 40-year retrospective review of 32,644 primary total hip arthroplasties from a single institutional registry. It defines the incidence, risk factors, fracture patterns, and treatment of intra-operative and post-operative periprosthetic femoral fractures. Fracture risk is analyzed by cement status, age, and gender.
The single most useful rule here: stem fixation, not patient demographics, drives most periprosthetic fracture risk. Intra-operative fracture is about 14 times more likely with uncemented stems, and the classic high-risk patient is a woman over 65 with poor bone stock. Slow down during broaching and impaction in these patients, and inspect the calcar.
When managing a post-operative fracture, the Vancouver classification dictates treatment through implant stability. A well-fixed stem (B1) gets ORIF. A loose stem (B2/B3) gets revision arthroplasty, which is why assessing fixation on imaging is the key decision point.
Know the numbers: 20-year post-operative fracture risk is 3.5%, and unlike intra-operative fractures it is independent of age and gender. As arthroplasty volumes rise, this complication will only become more common.
A 40-year retrospective review of 32,644 primary total hip arthroplasties from a single institutional registry. It defines the incidence, risk factors, fracture patterns, and treatment of intra-operative and post-operative periprosthetic femoral fractures. Fracture risk is analyzed by cement status, age, and gender.
The single most useful rule here: stem fixation, not patient demographics, drives most periprosthetic fracture risk. Intra-operative fracture is about 14 times more likely with uncemented stems, and the classic high-risk patient is a woman over 65 with poor bone stock. Slow down during broaching and impaction in these patients, and inspect the calcar.
When managing a post-operative fracture, the Vancouver classification dictates treatment through implant stability. A well-fixed stem (B1) gets ORIF. A loose stem (B2/B3) gets revision arthroplasty, which is why assessing fixation on imaging is the key decision point.
Know the numbers: 20-year post-operative fracture risk is 3.5%, and unlike intra-operative fractures it is independent of age and gender. As arthroplasty volumes rise, this complication will only become more common.