Increased risk for early periprosthetic fractures after uncemented total hip replacement

INTRODUCTION: The purpose of this study was to describe a new type of proximal periprosthetic fracture occurring within the first six weeks after total hip arthroplasty and to analyse possible causes of a rising incidence.

MATERIAL AND METHODS: Patient files and radiographs from 2,408 uncemented hip replacements were analysed and patients with a periprosthetic split fracture reaching from the calcar to the medial femoral shaft below the lesser trochanter were included.

RESULTS: A total of 28 fractures in 2,408 uncemented primary hip replacements were included. Almost all fractures were seen in women. No correlation with diagnosis, age, body mass index, operation time, operative technique or implant position could be demonstrated, but a possible correlation with post-operative mobilisation and pain treatment was observed. Trainees had more fractures than experienced surgeons (non-significant).

CONCLUSION: We conclude that the increasing use of uncemented hip replacements implies an increasing risk of perioperative femoral fracture. The cause of the fractures remains unclear, but is probably multifactorial.

FUNDING: not relevant.

TRIAL REGISTRATION: not relevant.