Long-Term Outcome and Risk Factors of Proximal Femoral Fracture in Uncemented and Cemented Total Hip Replacement in 3089 Hips

Proximal femoral fracture is a relatively common occurrence during total hip replacement (THR). The purpose of this study was to identify risk factors associated with proximal femoral fracture during THR and report the outcome of the femoral prosthesis in uncemented and cemented THR. Risk factors examined included surgical approach, patient demographics of age, sex, and body mass index type of femoral component fixation, and types of fracture treatment. 3089 hips were examined with up to 14-year follow-up (mean, 4.7 years). 2295 (74%) femoral stems were cemented and 794 (26%) were uncemented. 82 hips had a proximal femoral fracture for an incidence 2.7%. Uncemented stem insertion had a significantly higher fracture rate at 6.9% compared with cemented stems at 0.8% (P < .0001). Risk factors for proximal femoral fractures include anterolateral approach (P < .0001), uncemented femoral component fixation (P < .0001), and female sex (P = .0016). Treatment with cerclage wiring was the most common treatment and long-term femoral component stability was unaffected by the fracture for uncemented hips (P = .9694). For cemented femoral stems, the stem survival rate was significantly decreased in hips with a proximal fracture compared with those without (93.3% vs. 97.1%) at 7-year follow-up (P < .0001). This study identifies an “at risk” population based on surgical approach, sex, and the use of uncemented components for proximal femoral fracture during THA. Treatment with cerclage wiring in combination with tapered titanium proximally circumferentially coated implants yielded excellent clinical and radiographic results at mean of 4.7 years (range, 0.3-14 years) follow-up.