Stringer Mark R, Hooper Gary J, Frampton Christopher, Kieser David C, Deng Yi
Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, The University of Otago, Christchurch, New Zealand.
Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
ANZ J Surg. 2021 Mar;91(3):404-408. doi: 10.1111/ans.16611. Epub 2021 Feb 1.
Periprosthetic femoral fractures around total hip arthroplasty (THA) are increasing annually, and are a major cause for revision surgery in the New Zealand Joint Registry (NZJR). The aim of this study was to determine the timing and risk factors for periprosthetic femoral fractures in THA requiring revision surgery in the NZJR.
All patients with a primary THA who sustained a periprosthetic femoral fracture requiring revision THA recorded in the NZJR were reviewed to determine age, gender, body mass index, American Society of Anesthesiologists (ASA) rating and femoral stem fixation (cemented or uncemented). Revision rates were calculated per 100 component years (cy), and risk factors determined in the first 90 days, and beyond.
Between 1999 and 2017, there were 713 revision THA for periprosthetic femoral fractures. Early revision THA was significantly associated with ASA score and body mass index ≥40. There was no gender difference (P = 0.274). The revision rate in uncemented femoral stems (1.12/100 cy) was significantly higher (p < 0.001) than cemented stems (0.16/100 cy). After 90 days, the revision rate was significantly higher with increasing age (P < 0.001), males (P < 0.001) and higher ASA score (P < 0.001). The difference between cemented (0.07/100 cy) and uncemented (0.05/100 cy) stems did not reach statistical significance (P = 0.108).
The rate of revision THA for periprosthetic femoral fracture is higher in uncemented femoral stems in the first 90 days, and is significantly associated with ASA score and morbid obesity. After 90 days, the rate is lower for uncemented femoral stems, but did not reach statistical significance.
全髋关节置换术（THA）周围的假体周围股骨骨折每年都在增加，是新西兰关节登记处（NZJR）翻修手术的主要原因。本研究的目的是确定NZJR中需要翻修手术的THA患者假体周围股骨骨折的发生时间和危险因素。
对NZJR记录的所有因假体周围股骨骨折而需要翻修THA的初次THA患者进行回顾，以确定年龄、性别、体重指数、美国麻醉医师协会（ASA）分级和股骨干固定方式（骨水泥固定或非骨水泥固定）。每100个组件年（cy）计算翻修率，并确定术后90天内及之后的危险因素。
1999年至2017年期间，有713例因假体周围股骨骨折而进行的翻修THA。早期翻修THA与ASA评分和体重指数≥40显著相关。无性别差异（P = 0.274）。非骨水泥固定股骨干的翻修率（1.12/100 cy）显著高于骨水泥固定股骨干（0.16/100 cy）（p < 0.001）。90天后，随着年龄增加（P < 0.001）、男性（P < 0.001）和ASA评分升高（P < 0.001），翻修率显著升高。骨水泥固定（0.07/100 cy）和非骨水泥固定（0.05/100 cy）股骨干之间的差异未达到统计学意义（P = 0.108）。
在术后90天内，非骨水泥固定股骨干的假体周围股骨骨折翻修THA率较高，且与ASA评分和病态肥胖显著相关。90天后，非骨水泥固定股骨干的翻修率较低，但未达到统计学意义。
