Background: The purpose of this study was to determine the
demographics, incidence, and results of treatment of periprosthetic fractures
in a nationwide observational study.
Methods: In the years 1999 and 2000, 321 periprosthetic fractures
were reported to the Swedish National Hip Arthroplasty Register. All of the
associated hospital records were collected. At the time of follow-up, the
Harris hip score, a health-related quality-of-life measure (the EuroQol-5D
[EQ-5D] index), and patient satisfaction were used as outcome measurements. A
radiologist performed the radiographic evaluation.
Results: Ninety-one patients, with a mean age of 73.8 years,
sustained a fracture after one or several revision procedures, and 230
patients, with a mean age of 77.9 years, sustained a fracture after a primary
total hip replacement. Minor trauma, including a fall to the floor, and a
spontaneous fracture were the main etiologies for the injuries. A high number
of patients had a loose stem at the time of the fracture (66% in the primary
replacement group and 51% in the revision group). Eighty-eight percent of the
fractures were classified as Vancouver type B; however, there was difficulty
with preoperative categorization of the fractures radiographically. There was
a high failure rate resulting in a low short to mid-term prosthetic survival
rate. The sixty-six-month survival rate for the entire fracture group, with
reoperation as the end point, was 74.8% ± 5.0%. One factor associated
with fracture risk was implant design.
Conclusions: On the basis of these findings, we believe that
high-risk patients should have routine radiographic follow-up. Such a routine
could identify a loose implant and make intervention possible before a
fracture occurred. Furthermore, we recommend an exploration of the joint to
test the stability of the implant in patients with a Vancouver type-B fracture
in which the stability of the stem is uncertain.
Level of Evidence: Prognostic Level II. See Instructions
to Authors for a complete description of levels of evidence.