Background: With an aging population, the incidence of periprosthetic femoral fractures (PPFs) following total hip arthroplasty (THA) is increasing, presenting a significant challenge for Orthopaedic care. Multiple factors contribute to the risk of PPFs, including femoral stem design, alignment, and patient demographics. Current research indicates a strong association between PPFs and the use of cementless, collarless femoral stems. Our study aims to evaluate risk factors associated with PPFs, and to evaluate their outcomes.
Methods: A retrospective review of operating theatre records from 2021 to 2024 was conducted to identify periprosthetic femur fractures. Patient demographics including preoperative mobility score were collected. Pre-fracture radiographs were evaluated for risk factors including alignment (valgus/varus), cemented/cementless fixation, and stem type (collared/uncollared, Exeter/Accolade/Corail) in total hip replacement and hemiarthroplasty cases. Fractures were classified using the Vancouver system, and postoperative radiographs were assessed to determine fixation methods and whether treatment was operative or non-operative. Patient charts plus hip fracture database were reviewed to evaluate mortality rates and postoperative complications.
Results: A total of 68 patients sustained a periprosthetic femur fracture. Of these, 54 met the inclusion criteria for hip arthroplasty. The mean age was 79 years, with 56% of patients being female. Cemented fixation was used in 55% of cases. Uncollared stems are more common, accounting for 72% of cases. The most prevalent fracture type was Vancouver B2, observed in 32% of patients. Surgical management included 42 patients treated with fixation: 29 underwent open reduction internal fixation (ORIF), four had stem revision, and four received a combination. One patient underwent proximal femur replacement. Cable fixation was used in 32 cases.
Conclusions: Our study identifies a higher risk of periprosthetic fractures in females, as well as cemented fixation and uncollared stems. Data from Irish Registry show 60% are cementless, with 44% Accolade. From the 40% cemented stems, 96% are Exeter. It could be concluded that Exeter stems have a greater risk of periprosthetic fracture, as they are collarless stems. Additionally, ORIF was most frequently used treatment, which is promising given ORIF has been linked to reduced blood loss, shorter surgical time, and shorter hospital stays in PFF patients.
