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Mortality After Periprosthetic Femur Fractures During and After Primary and Revision Total Hip Arthroplasty

Maradit Kremers, Hilal, MD, MSc; Abdel, Matthew P., MD; Ransom, Jeanine E., BS; Larson, Dirk R., MS; Lewallen, David G., MD; Berry, Daniel J., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 15, 2019 - Volume 27 - Issue 10 - p 375–380
doi: 10.5435/JAAOS-D-17-00902
Research Article

Introduction: We determined mortality rates after intraoperative and postoperative periprosthetic femur fractures in primary and revision total hip arthroplasty (THA).

Methods: The study population comprised 522 intraoperative and 480 postoperative femur fractures in 26,250 primary THA patients and 590 intraoperative and 224 postoperative femur fractures in 4,532 revision THA patients. The risk of death was examined using Cox regression models.

Results: In primary THA, intraoperative periprosthetic femur fractures were not associated with excess risk of death (hazard ratio, 1.03; 95% confidence interval, 0.86 to 1.22). The risk of death was slightly elevated among primary THA patients with postoperative femur fractures (hazard ratio, 1.19; 95% confidence interval, 1.08 to 1.43), but the excess risk was only confined to patients with comorbid orthopaedic conditions. In revision THA, neither intraoperative nor postoperative periprosthetic femur fractures were associated with excess risk of death.

Conclusion: Periprosthetic femur fractures are not associated with excess mortality among primary osteoarthritis patients.

Level of Evidence: Level III

From the Department of Orthopedic Surgery (Dr. Maradit Kremers, Dr. Abdel, Dr. Lewallen, and Dr. Berry), and the Department of Health Sciences Research (Dr. Maradit Kremers, Ms. Ransom, and Mr. Larson), Mayo Clinic, Rochester, MN.

Correspondence to Dr. Maradit Kremers: maradit@mayo.edu

Dr. Abdel or an immediate family member serves as a paid consultant to Stryker and serves as a board member, owner, officer, or committee member of the American Association of Hip and Knee Surgeons, the International Congress for Joint Reconstruction, the Mid-America Orthopaedic Association, and the Minnesota Orthopaedic Society. Dr. Lewallen or an immediate family member has received royalties from Mako/Stryker and Zimmer Biomet; serves as a paid consultant to Acuitive Technologies and Zimmer Biomet; has stock or stock options held in Acuitive Technologies and Ketai Medical Devices; and serves as a board member, owner, officer, or committee member of the American Joint Replacement Registry and the Orthopaedic Research and Education Foundation. Dr. Berry or an immediate family member has received royalties from DePuy; serves as a paid consultant to Bodycad and DePuy; has stock or stock options held in Bodycad; has received research or institutional support from DePuy; and serves as a board member, owner, officer, or committee member of the American Joint Replacement Registry, the International Hip Society, and the Mayo Clinic Board of Governors. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Maradit Kremers, Ms. Ransom, and Mr. Larson.

© 2019 by American Academy of Orthopaedic Surgeons
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