Matthew P. Abdel
ORLANDO — Data from registries in the United States and United Kingdom show an increase in the number of primary total hip arthroplasty periprosthetic femur fractures, a problem that presents orthopedic surgeons with challenges, including changes they may need to make intraoperatively to prevent these fractures, a presenter said at the Current Concepts in Joint Replacement Winter Meeting.
The increase in periprosthetic femur fractures during THA may be due to increased popularity of the direct anterior approach (DAA), as well as the sheer numbers of primary THAs being done worldwide with cementless components, according to Matthew P. Abdel, MD.
“The [American Joint Replacement Registry]AJRR data at 3 years show that periprosthetic fracture is one of the top three failure modes after primary total hip arthroplasty,” he said. “Our Mayo Clinic series shows the number 2 reason for failure of primary total hip arthroplasty is periprosthetic fracture.”
In the Mayo Clinic study, Abdel said and his colleagues found a 14-fold decrease in intraoperative periprosthetic femur fractures when THA was performed with a cemented stem. In addition, the same study showed the demographic factors of female gender and patient age older than 65 years were associated with a greater risk of intraoperative fractures, he noted.
“We found that the vast majority of these occur with placement of the femoral component. Most of them occur at the calcar. Most are nondisplaced and the vast majority of these fractures can be treated with cerclage wire at the area of the fracture,” Abdel said.
He said it is theorized that the approach to the hip can contribute to this problem, particularly with the increasingly popular DAA.
According to Abdel, “There’s also a growing body of evidence indicating that that approach may have an early failure rate related to the femur with some of those being periprosthetic fracture.” – by Susan M. Rapp
Abdel MP, et al. Bone Joint J. 2016;doi:10.1302/0301-620X.98B4.37203.
Abdel MP. Paper 18. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 11-14, 2019; Orlando.
Disclosure: Abdel reports he has an individual product development agreement with Stryker.