Operative treatment of early peri-prosthetic femur fractures following primary total hip arthroplasty.

The risk factors for and results of operatively treated peri-prosthetic femoral fractures sustained within 90 days following primary THA were evaluated. 5,313 consecutive THAs were reviewed and 32 (0.60%) fractures were identified which included 9 A(g), 2 B(1), 18 B(2), 1 B(3), and 2 A(g)/B(2) fractures. 19 (61%) patients sustained 23 complications including 9 greater trochanter non-unions, 2 femoral shaft non-unions, 3 patients with Brooker III HO, and 2 deep infections. 7 patients (23%) required a second operative procedure and one patient required a third. Peri-prosthetic fractures were associated with advancing age, female gender, developmental hip dysplasia, and cementless metaphyseal engaging components, particularly flat wedge tapers. Overall, operative treatment of acute peri-prosthetic fractures is associated with a high rate of complications (61%) and re-operation (23%).