Early Periprosthetic Femur Fractures After Primary Cementless Total Hip Arthroplasty: High Risk of Periprosthetic Joint Infection and Subsequent Reoperation

BACKGROUND Periprosthetic femur fracture (PFF) following total hip arthroplasty (THA) is a leading cause of early reoperation. The objective of this study was to compare rates of periprosthetic joint infection (PJI) and reoperation following PFFs that occurred early postoperatively to those that occurred late. METHODS We retrospectively identified 173 consecutive surgically-managed PFFs following primary THA. Cases were categorized as “early” if they occurred within 90 days of THA (n=117) or “late” if they occurred following the initial 90 days (n=56). Mean age at time of PFF was 68 years (range, 26 to 96) and 60% were women. Mean body mass index was 29 (range, 16 to 52). Mean follow-up was 2 years (range, 0 to 13). Kaplan Meier survival analysis estimated cumulative incidences of PJI and reoperation. RESULTS Early PFFs had higher 2-year cumulative incidence of PJI (11 versus 0%, P<0.001) and reoperation (24 versus 13%, P=0.110). Following early PFF, 27 patients required reoperation (i.e., 13 for PJI, 5 for instability, 2 for re-fracture, 2 for painful hardware, 2 for nonunion, 1 for adverse local tissue reaction, 1 for aseptic loosening, and 1 for leg-length discrepancy). Following late PFF, 5 patients required reoperation (i.e., 3 for instability, 1 for re-fracture, and 1 for nonunion). CONCLUSION There are greater incidences of PJIs and overall reoperations following early PFFs compared to late PFFs after THA. In addition to focusing efforts on prevention of early PFFs, surgeons should consider antiseptic interventions to mitigate the increased risk of PJI after treatment of early PFF.