Abstract
BackgroundIntraoperative periprosthetic fractures (IPF) are a well-described complication following hip hemiarthroplasty. Our aims were to identify risk factors that characterize IPF and to investigate postoperative mobility.MethodsWe retrospectively reviewed 481 bipolar hemiarthroplasties for displaced femoral neck fractures; of which, 421 (87.5%) were performed without cement, from January 2013 to March 2018. Data on the patients’ demographics, comorbidities, femoral canal geometry (Dorr canal type, Canal Flare Index), surgeon’s experience (junior vs. senior surgeon), and timing of surgery (daytime vs. on-call duty) were obtained. In patients with intraoperative fractures, further information was obtained. Patient mobility was assessed using matched-pair analysis. Mobility was classified according to the NHFD mobility score. The chi-square test, Fisher’s exact test, and Fisher-Freeman-Halton exact test were used for comparison between categorical variables, while the Mann-Whitney U test was used for continuous variables. The data analysis was performed using SPSS.ResultsOf 481 procedures, 34 (7.1%) IPFs were encountered. The Dorr canal type C was identified as a significant risk factor (p = .004). Other risk factors included female sex (OR 2.30, 95% CI .872–6.079), stovepipe femur (OR 1.749, 95% CI .823–3.713), junior surgeon (OR 1.204, 95% CI .596–2.432), and on-call-duty surgery (OR 1.471, 95% CI .711–3.046), although none showed a significant difference. Of 34 IPFs, 25 (73.5%) were classified as Vancouver type A. The treatment of choice was cerclage wiring. Within the 12 matched pairs identified, the postoperative mobility was slightly worse for the IPF group (delta = .41).ConclusionsIPF is a serious complication with bipolar hemiarthroplasty. The identification of risk factors preoperatively, in particular femur shape, is crucial and should be incorporated into the decision-making process.
Highlights
Intraoperative periprosthetic fractures (IPF) are a well-described complication following hip hemiarthroplasty
Patients and methods Patients treated with a bipolar hemiarthroplasty from January 2013 to March 2018 following femoral neck fracture were included in this study and were retrospectively reviewed
There were 270 of 481 (56.1%) procedures performed during on-call duty, and 211 of 481 (43.9%) procedures were performed during the daytime
Summary
Intraoperative periprosthetic fractures (IPF) are a well-described complication following hip hemiarthroplasty. Our aims were to identify risk factors that characterize IPF and to investigate postoperative mobility. Associated with increasing age is a decrease in bone mineral density, as well as muscle mass and strength, increasing the risk of falls and fall-related injuries. 95% of hip fractures are caused by falls from standing height [1, 2]. In 2000, there were an estimated 424,000 hip fractures worldwide in men and 1,098,000 in women [3], and the incidence is projected to rise to 4.5 million by 2050 [4, 5]. A third of the patients have a long-term decrease in Bellova et al Journal of Orthopaedic Surgery and Research (2019) 14:432 daily activities and functionality that reduce their independence [6, 7]
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