# Intraoperative periprosthetic femoral fracture in cementless hip hemiarthroplasty for femoral neck fracture does not change long-term outcomes

## TL;DR

This study finds that intraoperative fractures during hip surgery for femoral neck fractures do not worsen long-term outcomes if properly managed.

## Contribution

The study provides new evidence that intraoperative periprosthetic femoral fractures do not negatively impact long-term outcomes in cementless hip hemiarthroplasty.

## Key findings

- IPFF occurred in 6.6% of patients during cementless hip hemiarthroplasty for femoral neck fractures.
- Long-term mortality, readmission, and revision rates were similar between patients with and without IPFF.
- Most IPFF cases were managed with fixation and allowed full weight-bearing postoperatively.

## Abstract

Purpose: Intraoperative periprosthetic femoral fracture (IPFF) is a known complication during hemiarthroplasty (HA), which may lead to inferior outcomes. Few studies have assessed the outcomes of IPFF in HA for displaced femoral neck fractures (FNF). This study aims to evaluate the incidence of IPFF in cementless HA for displaced FNF and compare long-term outcomes between patients with and without IPFF. Methods: We retrospectively reviewed institutional surgical data of patients who underwent cementless HA for displaced FNF from January 2010 to January 2022. The presence, location, and treatment of IPFF, as well as the effect of IPFF on postoperative weight-bearing, status were assessed. Mortality, readmission, and revision rates were compared between the IPFF and non-IPFF group. Results: A total of 1,586 patients were included in the study. 104 patients (6.6%) in the IPFF group vs. 1,482 patients (93.4%) in the non-IPFF group. The IPFF location was mostly the calcar (59.6%), followed by the greater trochanter (35.5%) and the femoral shaft (8.6%). Most fractures were treated with fixation (92.3%) and full weight-bearing postoperatively (95.1%). Surgery duration was longer in the IPFF group (p < 0.001). However, there were no significant differences between groups regarding 30-day, 90-day, and 1-year mortality rates, 90-day readmission rates, or revision rates at the latest follow-up. A multivariate binary logistic regression found similar long-term results. Conclusions: While IPFF remains a recognized complication of cementless HA for displaced FNF, its occurrence does not adversely affect long-term outcomes when appropriately managed.