PERIPROSTHETIC FRACTURES INTRA- AND POSTOPERATIVELY IN 3,340 CEMENTED HEMIARTHROPLASTY TAPER-SLIP STEMS IN A SINGLE CENTRE

Periprosthetic Fractures (PPF) are potentially devastating for patients and associated with mortality rates of 10–22% at one year in arthroplasty patients. Data capture of these injuries is challenging, with no inclusion of PPF in the Scottish Hip Fracture Audit and arthroplasty registries only capturing revision arthroplasty procedures. The vast majority of current literature focuses on PPF in Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). There is a gap in outcomes of patients undergoing cemented hip hemiarthroplasty. These patients are a frailer, more comorbid cohort and applying results of implants used for elective arthroplasty is ill advised. Our primary aim was to ascertain the number of intra-operative PPF (IOPPF) or post-operative PPF (POPPF) following cemented hip hemiarthroplasty in our centre. A retrospective cohort study was conducted of all patients with intracapsular neck of femur fractures managed with a cemented hemiarthroplasty in a single Scottish high volume trauma centre over a 8 year period (01/06/2025-31/12/2023). Patients were identified and Age, ASA, IOPPF, POPPF, UCS classification and management were collected. A total of 3340 patients were identified: 173 of these were JRI Furlong and 3127 were Exeter V-40 cemented hip hemiarthroplasty implants. Mean age was 80.5 (SD 9.7), Median ASA 3 (IQR 0). There were 29 (0.8%) IOPPF identified which all occurred at trial reduction of the implant. There were 51 (1.5%) POPPF which were classified by UCS classification as follows: A= 3, B1=7, B2=23, B3=1, C=7, D=2, F=6. Management as follows: 15 Revision arthroplasty, 14 extramedullary fixation, 1 femoral nail and plate combination, 3 cement in cement revision with fixation and 1 proximal femoral replacement. There is increased PPF associated with taper slip stems in cemented hip hemiarthroplasty than in THA compared to previous literature. Trial reduction is the sole cause for IOPPF in our study and should be undertaken, if deemed appropriate, with caution. While B2 was the most common fracture type, there was only one “log splitter” metaphyseal fracture pattern commonly associated with taper slip stems.