The purpose of this study was to compare the cumulative incidence of postoperative periprosthetic fracture (PPF) in a cohort of femoral neck fracture (FNF) patients treated with two commonly used cemented stems: either a collarless, polished, tapered Exeter stem or the anatomic Lubinus SP2 stem.
In this retrospective multicenter cohort study of a consecutive series of patients, we included 2528 patients of age 60 years and above with an FNF who were treated with either hemiarthroplasty or total hip arthroplasty using either a polished tapered Exeter stem or an anatomic Lubinus SP2 stem. The incidence of PPF was assessed at a minimum of 2 years postoperatively.
The incidence of PPF was assessed at a median follow-up of 47 months postoperatively. Thirty nine patients (1.5%) sustained a PPF at a median of 27 months (range 0–96 months) postoperatively. Two of the operatively treated fractures were Vancouver A (5%), 7 were Vancouver B1 (18%), 10 were Vancouver B2 (26%), 7 were Vancouver B3 (18%), and 13 were Vancouver C (32%). The cumulative incidence of PPF was 2.3% in the Exeter group compared with 0.7% in the SP2 group (p < 0.001). The HR was 5.4 (95% CI 2.4–12.5, p < 0.001), using the SP2 group as the denominator.
The Exeter stem was associated with a higher risk for PPF than the Lubinus SP2 stem. We suggest that the tapered Exeter stem should be used with caution in the treatment of FNF.
The study was registered at clinicaltrials.gov (identifier: NCT03326271).
Lindahl H, Oden A, Garellick G, Malchau H. The excess mortality due to periprosthetic femur fracture A study from the Swedish national hip arthroplasty register. Bone. 2007;40:1294–8. CrossRef
Shields E, Behrend C, Bair J, Cram P, Kates S. Mortality and financial burden of periprosthetic fractures of the femur. Geriatr Orthop Surg Rehabil. 2014;5:147–53. CrossRef
Mellner C, Eisler T, Borsbo J, Broden C, Morberg P, Mukka S. The Sernbo score predicts 1-year mortality after displaced femoral neck fractures treated with a hip arthroplasty. Acta Orthop. 2017;88:402–6. CrossRef
Mukka S, Sjöholm P, Chammout G, Kelly-Pettersson P, Sayed-Noor A, Sköldenberg O. External validity of the HOPE-trial—hemiarthroplasty compared to total hip arthroplasty for displaced femoral neck fractures in octogenarians. JBJS Open Access. 2019. https://doi.org/10.2106/JBJS.OA.18.00061. CrossRefPubMedPubMedCentral
Gitajn IL, Heng M, Weaver MJ, Casemyr N, May C, Vrahas MS, Harris MB. Mortality following surgical management of Vancouver B periprosthetic fractures. J Orthop Trauma. 2017;31:9–14. CrossRef
Märdian S, Perka C, Schaser KD, Gruner J, Scheel F, Schwabe P. Cardiac disease and advanced age increase the mortality risk following surgery for periprosthetic femoral fractures. Bone Jt J. 2017;99:921–6. CrossRef
Berend ME, Smith A, Meding JB, Ritter MA, Lynch T, Davis K. Long-term outcome and risk factors of proximal femoral fracture in uncemented and cemented total hip arthroplasty in 2551 hips. J Arthroplasty. 2006;21:53–9. CrossRef
Sidler-Maier CC, Waddell JP. Incidence and predisposing factors of periprosthetic proximal femoral fractures: a literature review. Int Orthop. 2015;39:1673–82. CrossRef
Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Jt J. 2016;98:291–7. CrossRef
Brodén C, Mukka S, Muren O, Eisler T, Boden H, Stark A, Sköldenberg O. High risk of early periprosthetic fractures after primary hip arthroplasty in elderly patients using a cemented, tapered, polished stem. Acta Orthop. 2015;86:169–74. CrossRef
Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish national hip arthroplasty register. J Arthroplasty. 2005;20:857–65. CrossRef
Lindahl H, Malchau H, Oden A, Garellick G. Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Jt Surg Br. 2006;88:26–30. CrossRef
Garellick G, Karrholm J, Lindahl H, Malchau H, Rogmark C, Rolfson O. The Swedish hip arthroplasty register annual report 2014. Sweden: 2015.
Inngul C, Enocson A. Postoperative periprosthetic fractures in patients with an exeter stem due to a femoral neck fracture: cumulative incidence and surgical outcome. Int Orthop. 2015;39:1683–8. CrossRef
Mukka S, Mellner C, Knutsson B, Sayed-Noor A, Skoldenberg O. Substantially higher prevalence of postoperative peri-prosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem. Acta Orthop. 2016;87:257–61. CrossRef
Mohammed J, Mukka S, Hedbeck CJ, Chammout G, Gordon M, Sköldenberg O. Reduced periprosthetic fracture rate when changing from a tapered polished stem to an anatomical stem for cemented hip arthroplasty: an observational prospective cohort study with a follow-up of 2 years. Acta Orthop. 2019. https://doi.org/10.1080/17453674.2019.1624339. CrossRefPubMedPubMedCentral
Brady OH, Garbuz DS, Masri BA, Duncan CP. The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty. 2000;15:59–62. CrossRef
Carli AV, Negus JJ, Haddad FS. Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture? Bone Jt J. 2017;99:50–9. CrossRef
Bhattacharyya T, Chang D, Meigs JB, Estok DM 2nd, Malchau H. Mortality after periprosthetic fracture of the femur. J Bone Jt Surg Am. 2007;89:2658–62. CrossRef
Sarvilinna R, Huhtala HS, Sovelius RT, Halonen PJ, Nevalainen JK, Pajamaki KJ. Factors predisposing to periprosthetic fracture after hip arthroplasty: a case ( n = 31)-control study. Acta Orthop Scand. 2004;75:16–20. CrossRef
Franklin J, Malchau H. Risk factors for periprosthetic femoral fracture. Injury. 2007;38:655–60. CrossRef
Cook RE, Jenkins PJ, Walmsley PJ, Patton JT, Robinson CM. Risk factors for periprosthetic fractures of the hip: a survivorship analysis. Clin Orthop Relat Res. 2008;466:1652–6. CrossRef
Thien TM, Chatziagorou G, Garellick G, Furnes O, Havelin LI, Makela K, et al. Periprosthetic femoral fracture within two years after total hip replacement: analysis of 437,629 operations in the nordic arthroplasty register association database. J Bone Jt Surg Am. 2014;96:e167. CrossRef
Raut S, Parker MJ. Medium to long term follow up of a consecutive series of 604 Exeter Trauma Stem Hemiarthroplasties (ETS) for the treatment of displaced intracapsular femoral neck fractures. Injury. 2016;47:721–4. CrossRef
Palan J, Smith MC, Gregg P, Mellon S, Kulkarni A, Tucker K, et al. The influence of cemented femoral stem choice on the incidence of revision for periprosthetic fracture after primary total hip arthroplasty: an analysis of national joint registry data. Bone Jt J. 2016;98:1347–54. CrossRef
Macpherson GJ, Hank C, Schneider M, Trayner M, Elton R, Howie CR, et al. The posterior approach reduces the risk of thin cement mantles with a straight femoral stem design. Acta Orthop. 2010;81:292–5. CrossRef
Thien TM, Thanner J, Kärrholm J. Randomized comparison between 3 surface treatments of a single anteverted stemdesign: 84 hips followed for 5 years. J Arthroplasty. 2010;25(3):437–444.e1. https://doi.org/10.1016/j.arth.2009.01.015. CrossRefPubMed
Breusch SJ, Lukoschek M, Kreutzer J, Brocai D, Gruen TA. Dependency of cement mantle thickness on femoral stem design and centralizer. J Arthroplasty. 2001;16:648–57. CrossRef
Ricci WM. Periprosthetic femur fractures. J Orthop Trauma. 2015;29:130–7. CrossRef
Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009;20:1633–50. CrossRef
Soderqvist A, Ekstrom W, Ponzer S, Pettersson H, Cederholm T, Dalen N, et al. Prediction of mortality in elderly patients with hip fractures: a two-year prospective study of 1,944 patients. Gerontology. 2009;55:496–504. CrossRef
Stewart NA, Chantrey J, Blankley SJ, Boulton C, Moran CG. Predictors of 5 year survival following hip fracture. Injury. 2011;42:1253–6. CrossRef
Drew JM, Griffin WL, Odum SM, Van Doren B, Weston BT, Stryker LS. Survivorship after periprosthetic femur fracture: factors affecting outcome. J Arthroplasty. 2016;31:1283–8. CrossRef
Boylan MR, Riesgo AM, Paulino CB, Slover JD, Zuckerman JD, Egol KA. Mortality following periprosthetic proximal femoral fractures versus native hip fractures. J Bone Jt Surg Am. 2018;100:578–85. CrossRef
Klein GR, Parvizi J, Rapuri V, Wolf CF, Hozack WJ, Sharkey PF, et al. Proximal femoral replacement for the treatment of periprosthetic fractures. J Bone Jt Surg Am. 2005;87:1777–811.
Kazi HA, Whitehouse SL, Howell JR, Timperley AJ. Not all cemented hips are the same: a register-based (NJR) comparison of taper-slip and composite beam femoral stems. Acta Orthop. 2019;90(3):214–9. https://doi.org/10.1080/17453674.2019.1582680. CrossRefPubMedPubMedCentral
- Increased risk for postoperative periprosthetic fracture in hip fracture patients with the Exeter stem than the anatomic SP2 Lubinus stem
Hans E. Berg
- Springer Berlin Heidelberg
European Journal of Trauma and Emergency Surgery
Official Publication of the European Society for Trauma and Emergency Surgery
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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