Background: 

Total hip replacement (THR) with a cemented polished taper-slip (PTS) femoral stem has excellent long-term results but is associated with a higher postoperative periprosthetic femoral fracture (PFF) risk compared with composite beam stems. This study aimed to identify risk factors associated with PFF revision following THR with PTS stems.

Methods: 

In a retrospective cohort study, 299,019 primary THRs using PTS stems from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) were included, with a median follow-up of 5.2 years (interquartile range [IQR], 3.1 to 8.2 years). The adjusted hazard ratio (HR) of PFF revision was estimated for each variable using multivariable Cox survival regression analysis.

Results: 

Of 299,019 THR cases, 1,055 underwent revision for PFF at a median time of 3.1 years (IQR, 1.0 to 6.1 years). The mean age (and standard deviation) was 72 ± 9.7 years, 64.3% (192,365 patients) were female, and 82.6% (247,126 patients) had an American Society of Anesthesiologists (ASA) class of 1 or 2. Variables associated with increased PFF were increasing age (HR, 1.02 per year), intraoperative fracture (HR, 2.57 [95% confidence interval (CI), 1.42 to 4.66]), ovaloid (HR, 1.96 [95% CI, 1.22 to 3.16]) and round cross-sectional shapes (HR, 9.58 [95% CI, 2.29 to 40.12]), increasing stem offset (HR, 1.07 per millimeter), increasing head size (HR, 1.04 per millimeter), THR performed from 2012 to 2016 (HR, 1.45 [95% CI, 1.18 to 1.78]), cobalt-chromium stem material (HR, 6.7 [95% CI, 3.0 to 15.4]), and cobalt-chromium stems with low-viscosity cement (HR, 22.88 [95% CI, 9.90 to 52.85]). Variables associated with a decreased risk of PFF revision were female sex (HR, 0.52 [95% CI, 0.45 to 0.59]), increasing stem length (HR, 0.97 per millimeter), and a ceramic-on-polyethylene bearing (HR, 0.55 [95% CI, 0.36 to 0.85]).

Conclusions: 

Increased risk of PFF revision was associated with PTS stems that are short, have high offset, are used with large femoral heads, are made of cobalt-chromium, or have ovaloid or round cross-sectional shapes. Large increases in PFF risk were associated with cobalt-chromium stems used with low-viscosity cement. Further study is required to confirm causation.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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初次全髋置换后修订椎体假体股骨的抛光锥滑水泥骨干的风险因素：来自英国，威尔士，北爱尔兰和马恩岛国家联合注册机构的一项基于注册机构的队列研究。

背景： 

与复合束干相比，用水泥抛光的锥形滑移（PTS）股骨干进行全髋关节置换（THR）具有出色的长期效果，但术后假体周围股骨骨折（PFF）的风险较高。这项研究旨在确定与TTS茎THR后PFF修订相关的危险因素。

方法： 

在一项回顾性队列研究中，纳入了使用来自英国，威尔士，北爱尔兰和马恩岛（NJR）的国家联合登记处的PTS茎的299,019例原发性THR，中位随访时间为5.2年（四分位间距[IQR]） ，从3.1到8.2年）。使用多变量Cox生存回归分析估算每个变量的PFF修订版调整后的危险比（HR）。

结果： 

在299,019例THR病例中，有1,055例接受了PFF修订，中位时间为3.1年（IQR，1.0至6.1年）。平均年龄（和标准差）为72±9.7岁，64.3％（192,365例患者）为女性，而82.6％（247,126例患者）为1或2级美国麻醉医师协会（ASA）。与PFF增加相关的变量年龄增加（HR，每年1.02），术中骨折（HR，2.57 [95％置信区间（CI），1.42至4.66]），椭圆形（HR，1.96 [95％CI，1.22至3.16]）和圆形交叉截面形状（HR，9.58 [95％CI，2.29至40.12]），增加杆偏移（HR，1.07每毫米），增加头部尺寸（HR，1.04每毫米），从2012年到2016年进行的THR（HR，1.45） [95％CI，1.18至1.78]，钴铬茎材料（HR，6.7 [95％CI，3.0至15.4]），以及钴铬茎和低粘度水泥（HR，22.88 [95％CI，9.90至52.85]。与降低PFF修订风险相关的变量是女性（HR，0.52 [95％CI，0.45至0.59]），茎长增加（HR，每毫米0.97）和聚乙烯陶瓷轴承（HR，0.55） [95％CI，0.36至0.85]。

结论： 

PTS翻修的风险增加与PTS茎短，具有高偏移，用于大股骨头，钴铬合金或椭圆形或圆形横截面形状有关。PFF风险的大幅度增加与低粘度水泥所用的钴铬茎有关。需要进一步研究以确认因果关系。

证据级别： 

治疗级别III。有关证据水平的完整说明，请参见《作者说明》。