Fracture After Hip Replacement

Sweden has a National Hip Arthroplasty Register. All orthopedic surgeons report information about hip replacement patients to the register. The results of this study come from the data on hip fracture after total hip replacement (THR) that was reported to the Register.

At the time of this study, the register had a record of 242,393 primary (first-time) THRs. An additional 28,000 reoperations and nearly 23,000 revisions were also included. The goal of the study was to find out how many THR patients have a hip fracture after hip replacement. Identifying risk factors might help prevent these fractures.

The authors report dislocations, implant loosening, and fracture were the three top reasons for reoperation after THR. A total of 321 periprosthetic femoral fractures were reported. This type of fracture occurs at the top of the femur (thighbone) near the implant. Minor trauma was reported as the most common event leading to fracture.

X-rays showed a common cause of fracture was a loose implant. A loose stem was reported in two-thirds of the primary THRs and over half of the revision group. Most of these patients knew the implant was loose. They were on a waiting list for revision surgery.

Analysis of data from the Swedish National Hip Arthroplasty Register shows a rise in the number of periprosthetic femoral fractures. This is an uncommon but serious complication. The authors suspect implant design may be a key risk factor. Fractures were more common in patients who had straight, short implant stems. Surgeons must select the implant carefully when choosing the right replacement for each patient.

Reference: 

Hans Lindahl, MD, et al. Three-Hundred and Twenty-One Periprosthetic Femoral Fractures. In The Journal of Bone and Joint Surgery. June 2006. Vol. 88A. No. 6. Pp. 1215-1222.

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