Intraoperative Femoral Fractures During Primary Total Hip Arthroplasty Are Associated With Increased Revision and Complication Rates.

Background: Intraoperative femoral fractures are a rare, but serious complication of primary total hip arthroplasty (THA), and little is known about the rates of complications and reoperations in these patients. The objective of this investigation was to describe the two-year outcomes and revision rates in patients who sustain an intraoperative femoral fracture during THA.

Methods: A large administrative claims database was queried for patients who sustained an intraoperative femoral fracture during primary and elective THA from 2015 to 2022. Patients requiring THA for tumors or fractures were excluded. Patients who sustained an intraoperative fracture were matched 1:1 based on age, sex, and comorbidity burden. The incidence of medical and surgical complications was compared between cohorts. Kaplan-Meier and multivariate analyses were used to compare two-year outcomes between groups.

Results: Among matched cohorts of 2,795 patients, those who sustained an intraoperative femoral fracture experienced higher rates of periprosthetic joint infection (PJI) (odds ratio [OR]: 2.0, P < 0.001), instability (OR: 1.6, P = 0.013), revision THA (OR: 2.7, P < 0.001), deep vein thrombosis (OR: 3.0, P < 0.001), and transfusion (OR: 2.8, P < 0.001) at 90 days and demonstrated significantly longer length of stay (5.7 ± 6.3 versus 3.6 ± 4.5 days, P < 0.001). At a 2-year follow-up, patients who had an intraoperative femoral fracture were more likely to develop a PJI (OR: 2.1, P < 0.001), periprosthetic fracture (OR: 1.6, P = 0.030), aseptic loosening (OR: 3.0, P < 0.001), and instability (OR: 1.7, P = 0.001) and undergo all-cause revision (OR: 2.3, P < 0.001).

Conclusions: Patients who sustained an intraoperative femoral fracture during primary THA were significantly more likely to develop PJI, periprosthetic fracture, aseptic loosening, instability, undergo revision THA, and experience medical complications. Strategies to mitigate intraoperative fracture during THA are necessary to improve outcomes in these high-risk patients.