Intraoperative periprosthetic femoral fractures (PFF) during the implantation of primary non-cemented total hip arthroplasties (THA) are an increasing problem. Thus, the goal of this study was to analyse the postoperative performance of primary non-cemented THA in patients with intraoperative PFFs, with respect to the patient's subjective health-related satisfaction.
42 PFFs in 1216 primary THAs using the non-cemented BiCONTACT stem were monitored. Patients were compared to a control group of 42 non-cemented THA patients without intraoperative fracture complications, using the matched-pair analysis. Preoperative and after 2.2 years (0.8-3.2 years), patients were followed-up clinically and radiographically. Clinical parameters were Harris hip score, SF-36 health score, function and pain score and postoperative complications. Radiographic parameters were bone union, stem and trochanter migration. Fractures were graded using the Vancouver classification.
Results showed a significant increase in both Harris hip score and motion score and a significant decrease in pain score in both groups (p<0.001). The SF-36 health score increased significantly in nearly every dimension in both groups. Except for 2 patients with trochanter migrations of 25 and 20 mm, all fractures showed bony union. In 3 patients the stems subsided by 4.7 +/- 2.9 mm. The stems showed no further migration at final follow-up. 2 patients without intraoperative fractures underwent stem revision. Overall increases and postoperative complication rates were not significantly different between the groups.
Mid-term THA performance and patient satisfaction are not influenced by intraoperative Vancouver A and B1 fractures during implantation of the non-cemented BiCONTACT stem compared to a collective without intraoperative fractures during implantation.