Impact of intraoperative femoral fractures in primary hip arthroplasty: a comparative study with a mid-term follow-up

• Published in: Hip international 2020-09, Vol.30 (5), p.544-551
• Main Authors: Ferbert, Thomas, Jaber, Ayham, Gress, Nathan, Schmidmaier, Gerhard, Gotterbarm, Tobias, Merle, Christian
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arthroplasty, Replacement, Hip - adverse effects; Female; Femoral Fractures - etiology; Femoral Fractures - surgery; Femur - surgery; Follow-Up Studies; Humans; Intraoperative Complications - etiology; Male; Middle Aged; Osteoarthritis, Hip - surgery; Patient Satisfaction; Reoperation - adverse effects; Retrospective Studies; Treatment Outcome
• ISSN: 1120-7000; 1724-6067
• DOI: 10.1177/1120700019849911

Background: Intraoperative femoral fractures (IFF) during primary total hip arthroplasty (THA) pose a major clinical challenge, and data on mid-term implant performance, functional outcome and patient satisfaction is limited. Methods: 50 patients who sustained IFFs during primary THA were retrospectively reviewed. A control group of patients who received a primary THA without complications was matched according to gender, age, body mass index and indication for THA. Both groups were followed-up for a minimum duration of 2 years. Average follow-up duration was 5.6 years (range 2–11.8 years) for the fracture group and 6 years (range 4.1–8.3 years) for the control group respectively. The following parameters were assessed and compared: stem revision, Harris Hip Score improvement, pain scale improvement, WOMAC, Tegner Score, UCLA, SF-36, forgotten joint score and patient satisfaction. Results: There were no stem revisions in the fracture group and 1 stem revision in the control group. Stem survival was 100% and 98.1% respectively (p = 0.447). The mean improvement in Harris hip score was 35.3 and 44.8 respectively. Significantly lower Harris Hip score improvement (p = 0.021) and patient satisfaction (p = 0.01) were observed in the fracture group. All other acquired parameters did not show significant differences. Conclusion: Intraoperative fractures of the proximal femur are a relevant complication that does not lead to higher revision rates but might worsen the functional outcome and negatively impact patient satisfaction in mid-term follow-up even if treated appropriately.