Risk factors for intraoperative femoral fractures in cementless bipolar hip arthroplasty for femoral neck fracture in multicenter: The TRON group study

Hiroaki Ido; Yasuhiko Takegami; Yusuke Osawa; Masanori Okamoto; Hiroki Iida; Shiro Imagama

doi:10.1016/j.jos.2024.01.005

Risk factors for intraoperative femoral fractures in cementless bipolar hip arthroplasty for femoral neck fracture in multicenter: The TRON group study

J Orthop Sci. 2024 Jan 31:S0949-2658(24)00006-X. doi: 10.1016/j.jos.2024.01.005. Online ahead of print.

Authors

Hiroaki Ido¹, Yasuhiko Takegami², Yusuke Osawa¹, Masanori Okamoto¹, Hiroki Iida¹, Shiro Imagama¹

Affiliations

¹ Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
² Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: takegami@med.nagoya-u.ac.jp.

PMID: 38302311
DOI: 10.1016/j.jos.2024.01.005

Abstract

Background: Intraoperative femoral fractures are more common in cementless bipolar hip arthroplasty (BHA) for displaced femoral neck fractures than they are in cemented BHA and remain one of the major concerns. This study aimed to investigate the risk factors for intraoperative femoral fractures in cementless BHA.

Methods: The study included 1,392 patients who underwent cementless BHA for displaced femoral neck fractures from January 2015 to December 2019 in 14 hospitals of the Trauma Research Group. They were divided into two groups according to the presence or absence of intraoperative femoral fractures, and factors associated with intraoperative fractures were statistically examined.

Results: Forty (2.9 %) intraoperative and 28 (2.0 %) postoperative, totally 68 (4.9 %) femoral fractures occurred. The mean age of the patients, presence of opposite-side proximal femoral fracture, approach, and cementless stem design were significantly different between the two groups (P < 0.05). The logistic regression analysis model showed that a fully HA-coated stem (odds ratio, 4.12; 95 % confidence interval, 1.43-11.9) was an independent factor associated with intraoperative femoral fractures.

Conclusion: This study investigated the risk factors associated with intraoperative fractures and showed that fully HA-coated stems were an independent factor associated with intraoperative femoral fractures. Surgeons should be cautious in the early stages of introducing fully HA-coated stems.

Keywords: Bipolar hip arthroplasty; Cementless bipolar hip arthroplasty; Displaced femoral neck fracture; Intraoperative femoral fracture; Stem design.