In a retrospective study, researchers identified several independent risk factors that increased the incidence of periprosthetic femoral fractures after total hip arthroplasty with use of a single stem.
Researchers analyzed the clinical and radiological data of 1,633 patients who underwent primary hip arthroplasty with a Collum femoris preserving stem (Waldemar Link GmbH) and identified the incidence, Vancouver classification and risk factors for intraoperative periprosthetic femoral fractures. Researchers obtained demographic characteristics from medical records and radiological features from the Picture Archiving and Communication System.
Results showed an incidence rate of periprosthetic femoral fractures of 3.2% in patients undergoing THA with a Collum femoris preserving stem. Researchers classified 45.3% of patients with Vancouver type A fractures, 50.9% with Vancouver type B fractures and 3.8% with Vancouver types C fractures. Independent risk (protective) factors for periprosthetic femoral fractures included surgical history, neck-shaft angle, neck length preserved, canal flare index and bone mineral density, according to results.
To avoid intraoperative periprosthetic femoral fractures in patients undergoing THA with a Collum femoris preserving stem, the authors recommend the stems be used with caution in patients with abnormal anatomical features of the proximal femur and severe osteoporosis. The researchers added that surgeons should maintain a sufficient preserved neck length during the operation and use of a Collum femoris preserving stem should be restricted among patients with previous surgical history unless the surgeon has “sufficient experience managing cancellous bone sclerosis of the femoral neck.”
“Finally, in many cases, the surgical skills of the surgeon are the most important factor influencing the incidence of periprosthetic fractures,” the authors wrote. “Therefore, we believe that thorough soft tissue release should be performed, if necessary, to remove the acetabular osteophyte, and the use of violent surgical maneuvers should be avoided during dislocation of the hip joint. Carefully reaming the medullary canal and employing gentle manipulation, especially when inserting the stem, can also effectively reduce the occurrence of [periprosthetic femoral fractures] PFFs.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.