Perspective
Periprosthetic femoral fractures after total hip arthroplasty Total hip arthroplasty (THA) is an effective surgery with relatively low probability of complications. However, periprosthetic femoral fracture is a potentially devastating complication, with the reported incidence varying between 0.1% and 18%.1 Periprosthetic femoral fracture is associated with high rate of postoperative complications, often showing poor clinical result and increased mortality rate.2 As more periprosthetic fractures around THAs are encountered, it requires good understanding, accurate classification and subsequent treatment decisions taken accordingly.3 A look at risk factors can provide an insight into the preventive aspects and taking precautionary steps would minimize periprosthetic fractures after THA and its complications.
Epidemiology of periprosthetic femoral fractures after THA
Dr. Sanjib Kumar Behera MS (Ortho), DNB (Rehab), ISAKOS (France), DPMR Consultant Orthopaedic Surgeon
The incidence of periprosthetic femoral fractures following THA, though difficult to determine due to problems with long-term follow-up, varies by more than 10-fold, depending on clinical situation. Incidence is much higher after revision surgery than primary THA and is higher with use of uncemented stems. Intraoperative fractures are more common in these cases due to a need for tight press fit and force required to obtain such a fit. Rates reportedly varied from 4.1% to 27.8% after uncemented THA, as compared to <3% with use of cemented stems.4
Risk factors for periprosthetic femoral fractures Bony pathologies / deformities Higher risks for intraoperative fractures exist in rheumatoid arthritis than osteoarthritis, probably due to osteopenia / osteoporosis, and in cases of increased bone fragility (osteomalacia, Pagetâ&#x20AC;&#x2122;s 3