Impact of intraoperative femoral fractures in primary hip arthroplasty: a comparative study with a mid-term follow-up

Hip Int. 2020 Sep;30(5):544-551. doi: 10.1177/1120700019849911. Epub 2019 May 17.


Background: Intraoperative femoral fractures (IFF) during primary total hip arthroplasty (THA) pose a major clinical challenge, and data on mid-term implant performance, functional outcome and patient satisfaction is limited.

Methods: 50 patients who sustained IFFs during primary THA were retrospectively reviewed. A control group of patients who received a primary THA without complications was matched according to gender, age, body mass index and indication for THA. Both groups were followed-up for a minimum duration of 2 years. Average follow-up duration was 5.6 years (range 2-11.8 years) for the fracture group and 6 years (range 4.1-8.3 years) for the control group respectively. The following parameters were assessed and compared: stem revision, Harris Hip Score improvement, pain scale improvement, WOMAC, Tegner Score, UCLA, SF-36, forgotten joint score and patient satisfaction.

Results: There were no stem revisions in the fracture group and 1 stem revision in the control group. Stem survival was 100% and 98.1% respectively (p = 0.447). The mean improvement in Harris hip score was 35.3 and 44.8 respectively. Significantly lower Harris Hip score improvement (p = 0.021) and patient satisfaction (p = 0.01) were observed in the fracture group. All other acquired parameters did not show significant differences.

Conclusion: Intraoperative fractures of the proximal femur are a relevant complication that does not lead to higher revision rates but might worsen the functional outcome and negatively impact patient satisfaction in mid-term follow-up even if treated appropriately.

Keywords: Cerclage; femur fracture; intraoperative complication; outcome; total hip arthroplasty; trochanter major fracture.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Female
  • Femoral Fractures / etiology*
  • Femoral Fractures / surgery
  • Femur / surgery
  • Follow-Up Studies
  • Humans
  • Intraoperative Complications / etiology*
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / surgery*
  • Patient Satisfaction
  • Reoperation / adverse effects
  • Retrospective Studies
  • Treatment Outcome