TY - JOUR

T1 - Introduction of a New Treatment Algorithm Reduces the Number of Periprosthetic Femoral Fractures After Primary Total Hip Arthroplasty in Elderly Females

AU - Omari, Adam

AU - Nielsen, Christian S.

AU - Husted, Henrik

AU - Otte, Kristian S.

AU - Troelsen, Anders

AU - Gromov, Kirill

PY - 2020

Y1 - 2020

N2 - Background: Increasing global usage of cementless prostheses in total hip arthroplasty (THA) presents a challenge, especially for elderly patients. To reduce the risk of early periprosthetic femoral fractures (PFFs), a new treatment algorithm for females older than 60 years undergoing primary THA was introduced. The aim of this study was to determine the impact of the new treatment algorithm on the early risk of perioperative and postoperative PFFs and guideline compliance. Methods: A total of 2405 consecutive THAs that underwent primary unilateral THA at our institution were retrospectively identified in the period January 1, 2013-December 31, 2018. A new treatment algorithm was introduced on April 1, 2017 with female patients aged older than 60 years intended to receive cemented femoral components. Before this, all patients were scheduled to receive cementless femoral components. Demographic data, number of perioperative and postoperative PFFs, and surgical compliance were recorded, analyzed, and intergroup differences compared. Results: The utilization of cemented components in female patients older than 60 years increased from 12.3% (n = 102) to 82.5% (n = 264). In females older than 60 years, a significant reduction in the risk in early postoperative and intraoperative PFF after introduction of the new treatment algorithm was seen (4.57% vs 1.25%; P = .007 and 2.29% vs 0.31%; P = .02, respectively). Overall risk for postoperative and intraoperative fractures combined was also reduced in the entire cohort (4.1% vs 2.0%; P = .01). Conclusion: Use of cemented fixation of the femoral component in female patients older than 60 years significantly reduces the number of PFFs. Our findings support use of cemented femoral fixation in elderly female patients.

AB - Background: Increasing global usage of cementless prostheses in total hip arthroplasty (THA) presents a challenge, especially for elderly patients. To reduce the risk of early periprosthetic femoral fractures (PFFs), a new treatment algorithm for females older than 60 years undergoing primary THA was introduced. The aim of this study was to determine the impact of the new treatment algorithm on the early risk of perioperative and postoperative PFFs and guideline compliance. Methods: A total of 2405 consecutive THAs that underwent primary unilateral THA at our institution were retrospectively identified in the period January 1, 2013-December 31, 2018. A new treatment algorithm was introduced on April 1, 2017 with female patients aged older than 60 years intended to receive cemented femoral components. Before this, all patients were scheduled to receive cementless femoral components. Demographic data, number of perioperative and postoperative PFFs, and surgical compliance were recorded, analyzed, and intergroup differences compared. Results: The utilization of cemented components in female patients older than 60 years increased from 12.3% (n = 102) to 82.5% (n = 264). In females older than 60 years, a significant reduction in the risk in early postoperative and intraoperative PFF after introduction of the new treatment algorithm was seen (4.57% vs 1.25%; P = .007 and 2.29% vs 0.31%; P = .02, respectively). Overall risk for postoperative and intraoperative fractures combined was also reduced in the entire cohort (4.1% vs 2.0%; P = .01). Conclusion: Use of cemented fixation of the femoral component in female patients older than 60 years significantly reduces the number of PFFs. Our findings support use of cemented femoral fixation in elderly female patients.

KW - fixation method

KW - hip

KW - outcomes

KW - periprosthetic femoral fracture

KW - total hip arthroplasty

U2 - 10.1016/j.arth.2020.06.077

DO - 10.1016/j.arth.2020.06.077

M3 - Journal article

C2 - 32768258

AN - SCOPUS:85089109892

VL - 35

SP - 3613

EP - 3620

JO - Journal of Arthroplasty

JF - Journal of Arthroplasty

SN - 0883-5403

IS - 12

ER -