Occurrence and Determinants of Periprosthetic Fractures of the Femur During Intraoperative and Post-operative Period in Patients Undergoing Hip Arthroplasty: A Prospective Cohort Study.

Authors

Amit Kumar, Vijay Kumar Jain, Abdus Sami

Published in

Indian journal of orthopaedics. Volume 60. Issue 10. Pages 2849-2858. Epub May 12, 2026.

Abstract

Periprosthetic femoral fractures (PPFs) are serious complications of hip arthroplasty, leading to increased morbidity and the need for revision surgery. Data on determinants of PPFs in Indian populations are limited. This study aimed to evaluate the occurrence and risk factors for PPFs during intraoperative and postoperative periods in patients undergoing hemiarthroplasty (HA) or total hip arthroplasty (THA).
A prospective cohort study was conducted at a tertiary care center between January 2021 and December 2022. Patients aged 18-80 years undergoing primary HA or THA were enrolled. Demographic, clinical, biochemical, and radiological data-including bone mineral density (BMD), serum vitamin D₃ levels, comorbidities, and femoral morphology (Dorr classification)-were collected. Surgical details and postoperative outcomes were recorded. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of PPFs.
Among 402 patients, 25 (6.2%) sustained PPFs, all intraoperatively. Fractures predominantly involved the greater trochanter (92%). Multivariate analysis identified Dorr type C femoral canal (adjusted OR [aOR] 13.5, 95% CI 3.06-59.3), severe osteoporosis (BMD T ≤ - 2.5; aOR 5.63, 95% CI 1.56-20.3), and absence of preoperative vitamin D₃ supplementation (aOR 0.20, 95% CI 0.08-0.50) as independent predictors of PPFs. Other significant associations were advanced age, diabetes, hypertension, COPD, smoking, bipolar hemiarthroplasty, anterolateral approach, and higher ASA grade.
PPFs during hip arthroplasty are multifactorial, with bone quality, femoral canal morphology, and preoperative vitamin D₃ supplementation being key determinants. Preoperative optimization of bone health and careful surgical planning can reduce fracture risk and improve outcomes in high-risk patients.

PMID:
42871509
Bibliographic data and abstract were imported from PubMed on 14 Oct 2026.

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