TY - JOUR

T1 - Inferior outcome after intraoperative femoral fracture in total hip arthroplasty: outcome in 519 patients from the Danish Hip Arthroplasty Registry

AU - Thillemann, Theis

AU - Pedersen, Alma B

AU - Johnsen, Søren P

AU - Søballe, Kjeld

PY - 2008

Y1 - 2008

N2 - BACKGROUND: Intraoperative femoral fracture is a well known complication of primary total hip arthroplasty (THA). Experimental studies have indicated that intraoperative fractures may affect implant survival. Very few clinical data are available, however. METHODS: We used data from the Danish Hip Arthroplasty Registry to identify patients in Denmark who underwent a primary THA due to primary osteoarthritis between 1995 and 2005 (n = 39,478). Data were linked to two national Danish databases in order to conduct time-dependent implant survival analyses. Implant survival and relative risk estimates were calculated for patients treated nonoperatively and for patients treated with osteosynthesis after sustaining intraoperative femoral fractures during THA surgery. THAs performed without sustaining intraoperative femoral fracture served as the reference group. RESULTS: 282 patients (0.7%) were treated non operatively due to intraoperative femoral fracture and 237 patients (0.6%) were treated with osteosynthesis. In the 0-6 month postoperative period, the adjusted relative risk (RR) of revision was 1.5 (95% CI: 1.1-1.7) for patients treated nonoperatively and 5.7 (3.3-10) for patients treated with osteosynthesis. In the period from 6 months to 11 years postoperatively, we did not find any statistically significant differences in the RR of revision between the groups. INTERPRETATION: Intraoperative fractures increase the relative risk of revision during the first 6 postoperative months. Thus, patients should be informed about the risk of revision after sustaining an intraoperative femoral fracture. Furthermore, initiatives aimed at reducing the risk of revision in the first 6 months following THA should be considered in patients with intraoperative fractures, including immediate change to a larger stem with distal fixation and restricted weight bearing.

AB - BACKGROUND: Intraoperative femoral fracture is a well known complication of primary total hip arthroplasty (THA). Experimental studies have indicated that intraoperative fractures may affect implant survival. Very few clinical data are available, however. METHODS: We used data from the Danish Hip Arthroplasty Registry to identify patients in Denmark who underwent a primary THA due to primary osteoarthritis between 1995 and 2005 (n = 39,478). Data were linked to two national Danish databases in order to conduct time-dependent implant survival analyses. Implant survival and relative risk estimates were calculated for patients treated nonoperatively and for patients treated with osteosynthesis after sustaining intraoperative femoral fractures during THA surgery. THAs performed without sustaining intraoperative femoral fracture served as the reference group. RESULTS: 282 patients (0.7%) were treated non operatively due to intraoperative femoral fracture and 237 patients (0.6%) were treated with osteosynthesis. In the 0-6 month postoperative period, the adjusted relative risk (RR) of revision was 1.5 (95% CI: 1.1-1.7) for patients treated nonoperatively and 5.7 (3.3-10) for patients treated with osteosynthesis. In the period from 6 months to 11 years postoperatively, we did not find any statistically significant differences in the RR of revision between the groups. INTERPRETATION: Intraoperative fractures increase the relative risk of revision during the first 6 postoperative months. Thus, patients should be informed about the risk of revision after sustaining an intraoperative femoral fracture. Furthermore, initiatives aimed at reducing the risk of revision in the first 6 months following THA should be considered in patients with intraoperative fractures, including immediate change to a larger stem with distal fixation and restricted weight bearing.

KW - Adolescent

KW - Adult

KW - Aged

KW - Arthroplasty, Replacement, Hip

KW - Child

KW - Denmark

KW - Female

KW - Femoral Fractures

KW - Follow-Up Studies

KW - Humans

KW - Intraoperative Complications

KW - Length of Stay

KW - Male

KW - Middle Aged

KW - Osteoarthritis, Hip

KW - Prosthesis Failure

KW - Registries

KW - Reoperation

KW - Treatment Outcome

U2 - 10.1080/17453670710015210

DO - 10.1080/17453670710015210

M3 - Journal article

C2 - 18622835

VL - 79

SP - 327

EP - 334

JO - Acta Orthopaedica (Print Edition)

JF - Acta Orthopaedica (Print Edition)

SN - 1745-3674

IS - 3

ER -