Lamb, JN orcid.org/0000-0002-0166-9406, Matharu, GS, Redmond, A orcid.org/0000-0002-8709-9992 et al. (3 more authors) (2019) Patient and implant survival following intraoperative periprosthetic femoral fractures during primary total hip arthroplasty. An analysis from the National Joint Registry for England, Wales and the Isle of Man. Bone and Joint Journal, 101-B (10). pp. 1199-1208. ISSN 2049-4394
Abstract
Aims
We compared implant and patient survival following intraoperative periprosthetic femoral fractures (IOPFFs) during primary total hip arthroplasty (THA) with matched controls.
Patients and Methods
This retrospective cohort study compared 4831 hips with IOPFF and 48 154 propensity score matched primary THAs without IOPFF implanted between 2004 and 2016, which had been recorded on a national joint registry. Implant and patient survival rates were compared between groups using Cox regression.
Results
Ten-year stem survival was worse in the IOPFF group (p < 0.001). Risk of revision for aseptic loosening increased 7.2-fold following shaft fracture and almost 2.8-fold after trochanteric fracture (p < 0.001). Risk of periprosthetic fracture of the femur revision increased 4.3-fold following calcar-crack and 3.6-fold after trochanteric fracture (p < 0.01). Risk of instability revision was 3.6-fold after trochanteric fracture and 2.4-fold after calcar crack (p < 0.001). Risk of 90-day mortality following IOPFF without revision was 1.7-fold and 4.0-fold after IOPFF with early revision surgery versus uncomplicated THA (p < 0.001).
Conclusion
IOPFF increases risk of stem revision and mortality up to ten years following surgery. The risk of revision depends on IOPFF subtype and mortality risk increases with subsequent revision surgery. Surgeons should carefully diagnose and treat IOPFF to minimize fracture progression and implant failure.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | ©2019 The British Editorial Society of Bone & Joint Surgery. This is an author produced version of a paper published in The Bone and Joint Journal. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Hip; Intraoperative fracture; IOPFF; Calcar crack; Shaft fracture; Trochanteric fracture; Stem revision; Mortality |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Orthopaedics (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Centre for Health Services Research (Leeds) |
Funding Information: | Funder Grant number The John Charnley Trust Not Known |
Depositing User: | Symplectic Publications |
Date Deposited: | 22 Jul 2019 09:48 |
Last Modified: | 30 Sep 2020 00:38 |
Status: | Published |
Publisher: | British Editorial Society of Bone and Joint Surgery |
Identification Number: | 10.1302/0301-620X.101B10.BJJ-2018-1596.R1 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:148797 |