Incidence and risk factors of intraoperative periprosthetic femoral fractures during primary total hip arthroplasty: 218,423 cases reported to the Norwegian Arthroplasty Register between 1987 and 2020

BACKGROUND AND PURPOSE: Intraoperative periprosthetic femoral fractures (IPFFs) can occur during primary total hip arthroplasty (THA). We describe the incidence of IPFFs during THA in Norway and estimate potential risk factors that could be associated with IPFF PATIENTS AND METHODS: Data from the Norwegian Arthoplasty Register (1987–2020) was used: 2,268 IPFFs from 218,423 primary THAs in 172,598 patients. The following factors were analyzed: sex, age, diagnosis, previous operation on the same hip, surgical approach, and stem fixation technique. Association of these factors with IPFF risk was assessed using multivariable Poisson regression. RESULTS: IPFF occurred during 2,268 operations with an incidence of 1.0% among all primary THAs. The risk of IPFF was associated with female sex (relative risk 1.8; 99% CI 1.5–2.1), age 80–90 years and age over 90 years (compared with age 60–70 years: 1.3; CI 1.0–1.6 and 2.6; CI 1.6–4.3, respectively), non-osteoarthritis diagnoses (2.2; CI 1.9–2.6), previous surgery to the same hip (1.8; CI 1.5–2.2), lateral approach (compared with the posterior approach: 1.5; CI 1.1–2.0), and cementless stem fixation (2.7; CI 2.0–3.6). INTERPRETATION: Surgeons should be aware of the factors associated with an increased risk of IPFF: female sex, age above 80 years, non-osteoarthritis diagnoses, and previous surgery to the same hip. Cemented stem fixation and posterior approach should be favored in high-risk patients, such as elderly women.