Abstract
Intraoperative periprosthetic femoral fractures (IPFF) have been studied extensively for total hip arthroplasties, but not for hemiarthroplasties. Recent series in the literature show an IPFF rate for hemiarthroplasties ranging from 0% to 14%. The present study was designed to determine the prevalence and outcome after IPFF during non-cemented hemiarthroplasty. In addition, the surgical step at higher risk to produce these fractures was evaluated in an attempt to identify strategies that could minimize the prevalence of this complication. We performed an observational study of 365 consecutive patients undergoing and Austin-Moore hemiarthroplasty from 2005 to 2006 at our institution. The institutional IPFF rate was 6.8% (twenty-five out of 365). The moment at which the fracture was detected was collected: 1) intraoperatively and 2) in the postoperative radiological control. The surgical step in which the fracture occurred was collected: 1) neck osteotomy, 2) broaching, 3) prosthesis introduction, and 4) reduction. Results were compared to a control group according to blood transfusion rate, mortality rate and revision surgery rate. The fractures were detected during the surgery in twenty cases (80%); for the five remaining cases the fracture was only detected in the postoperative radiology. For those detected during the surgery, the two most common manouvers in which the fracture occurred was hip reduction (10 cases) and prosthesis introduction (7 cases). The blood transfusion rate, first-month mortality rate and revision surgery rate showed no statistical difference between the two groups (p = 0.3). In the present series, most of IPFF during Austin-Moore hemiarthroplasty implantation, occurred during arthroplasty reduction. Difficulties during this step should lead the surgeon to reconsider if technical mistakes are present and can be solved. However, if fracture occurs, adequate treatment of IPFF should provide satisfactory results without increasing blood transfusion needs, mortality or revision surgery.
Highlights
Intraoperative periprosthetic femoral fractures (IPFF) have been studied extensively for total hip arthroplasties, and revision surgery of THA shows the higher risk for this complication [1]
The present study aims to determine the incidence of IPFF implanting the Austin-Moore arthroplasties in the elderly patient at our institution, the surgical step at higher risk to produce these fractures and the outcomes regarding a control group without IPFF
No intraoperative Vancouver A1 fractures occurred, nor any Vancouver B or C type fractures. For those IPFF detected during the sugery, the moment in which the fracture occurred was; ten cases during hip reduction, seven cases during prosthesis introduction, one case during the femoral neck osteotomy, one case during broaching and in one case a dislocation and a periprosthetic fracture was observed in the intraoperative radiology control
Summary
Intraoperative periprosthetic femoral fractures (IPFF) have been studied extensively for total hip arthroplasties, and revision surgery of THA shows the higher risk for this complication [1]. In a large cohort study, it was reported that IPFF were encountered during 1% (238) of 23,980 primary THA compared with 7.8% (497) of 6349 revisions [2], and other studies have shown similar results [3,4,5]. Whereas the literature attention on prevention of IPFF is focused on total hip arthroplasty and mostly for revision procedures, very recent studies show that the pri-. Despite hemiarthroplasty remains the goldstandard treatment for femoral neck fractures in the elderly, these fractures and their treatment have been under-reported in the literature [6]. The present study aims to determine the incidence of IPFF implanting the Austin-Moore arthroplasties in the elderly patient at our institution, the surgical step at higher risk to produce these fractures and the outcomes regarding a control group without IPFF
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