Periprosthetic Atypical Femoral Fractures in Patients on Long-term Bisphosphonates

Abstract

To define the characteristics of periprosthetic atypical femoral fractures (PAFFs) in patients on long-term bisphosphonate treatment and to provide a guide to the diagnosis and long-term treatment of these patients based on the literature. Multicenter retrospective review. Fifteen orthopaedic centers in the United States and Canada, including members of the Canadian Orthopaedic Trauma Society. Patients on long-term bisphosphonates who presented with either periprosthetic fractures or femoral fractures, over a 10-year period. Time to union and complications. Clinically significant differences were identified in time to union, mortality, and complications. There was a statistically significant difference in complications. Imaging review demonstrated identical features in both atypical femoral fractures (AFFs) and PAFFs. This is the largest comparative case series reported on PAFFS and AFFs and provides compelling evidence that PAFFs in patients on long-term bisphosphonates are indeed a subset of periprosthetic fractures that exhibit atypical femoral fracture (AFF) characteristics. As such, these fractures pose serious diagnostic and management challenges to trauma and arthroplasty surgeons. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.