A comparison between Austin-Moore and Corail prosthesis regarding intraoperative periprosthetic femur fractures in hip hemiarthroplasty

Hip hemiarthroplasty is considered the treatment of choice for displaced femoral neck fractures in elderly less active patients. One important complication of this procedure is an intraoperative periprosthetic femur fracture (IPF), which may lead to poor functional outcome and may increase morbidity and mortality. Our primary aim in this study is to compare between Austin-Moore and Corail prosthesis regarding IPFs. Our secondary aim is to assess patient and surgical technique related risk factors for the development of this complication. Inclusion criteria included patients older than 65 years of age who had a displaced femoral neck fracture and were operated for hip hemiarthroplasty between the years 2014–2018. Patient-specific data was collected retrospectively including age, gender, comorbidities, pre-injury ambulatory status, duration of surgery, surgical approach, use of Austin-Moore or Corail prosthesis, surgeon’s experience and type of anesthesia applied. In addition, radiographs were reviewed for measurement of calcar to canal ratio (CDR) and classification of Dorr canal type. 257 patients with an average age of 83.7 years were enrolled in the study. 118 patients (46%) were treated with an Austin-Moore prosthesis, while 139 (54%) were treated with a Corail prosthesis. A total of 22 patients (8.6%) had intraoperative fractures. Fracture prevalence was significantly higher in the Corail group compared with the Austin-Moore group (12.2% vs. 4.2%, p = 0.025). The majority of patients had a Dorr A type femoral canal, while the rest had Dorr B type canal (70% vs. 30%). There was no difference in fracture prevalence between Dorr A and B canal type patients. We didn’t find any significant risk factor for developing an IPF, neither patient wise (age, gender, and comorbidities) nor surgical technique related (surgical approach, type of anesthesia, and surgeon’s experience). Intraoperative periprosthetic fracture prevalence was significantly higher in the Corail patient group compared with the Austin-Moore group. This may be an important advantage of the Austin-Moore prosthesis over the Corail prosthesis.