ABSTRACT

Total hip arthroplasty is a functional and radiologically successful orthopedic operation, commonly performed over the last 30 years. The aim of our study was to investigate the prevalence and functional results of periprosthetic femur fractures occurring during the course of surgery.

Institutional review board approval was obtained prior to initiation of this study. We examined 94 hips of 91 patients, who underwent surgery in our centre between 2005 and 2011 and had a periprosthetic femur fracture. The fractures were classified based on the Vancouver classification. The methods used for fracture treatment were recorded, and during the surgery the step at which the fracture occurred was noted (broaching, reaming, stem insertion or reduction). At final follow-up, pelvis and femur anterior-to-posterior radiographies of the operated side were taken, and WOMAC scores were assessed. We compared the radiographs taken at the previous controls and last controls, to determine if there was a subsidence of the femoral stem.

Most of the fractures were occurred during the insertion of femoral stem phase (81% of patients). The mean WOMAC score at the last follow-up of the patients was 27 (8-81). Twelve (13%) hips had subsidence in the prosthesis, of which six underwent revision surgery. There was no significant difference between patients with or without subsidence and the fracture type (p=0.2). The mean WOMAC score of patients with femoral subsidence increased to 57, which was significantly different from that of patients without femoral subsidence (p<0.0001).

Intraoperative femur fractures occurring during total hip arthroplasty may lead to long-term subsidence of the femoral stem and subsequent implant failure. We could not determine the relationship between this type of fracture and subsidence. There was no significant deterioration in the hip function due to subsidence.

Keywords: Intraoperative fractures, periprosthetic, total hip prosthesis