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AIMS: We compared implant and patient survival following intraoperative periprosthetic femoral fractures (IOPFFs) during primary total hip arthroplasty (THA) with matched controls. PATIENTS AND METHODS: This retrospective cohort study compared 4831 hips with IOPFF and 48 154 propensity score matched primary THAs without IOPFF implanted between 2004 and 2016, which had been recorded on a national joint registry. Implant and patient survival rates were compared between groups using Cox regression. RESULTS: Ten-year stem survival was worse in the IOPFF group (p < 0.001). Risk of revision for aseptic loosening increased 7.2-fold following shaft fracture and almost 2.8-fold after trochanteric fracture (p < 0.001). Risk of periprosthetic fracture of the femur revision increased 4.3-fold following calcar-crack and 3.6-fold after trochanteric fracture (p < 0.01). Risk of instability revision was 3.6-fold after trochanteric fracture and 2.4-fold after calcar crack (p < 0.001). Risk of 90-day mortality following IOPFF without revision was 1.7-fold and 4.0-fold after IOPFF with early revision surgery versus uncomplicated THA (p < 0.001). CONCLUSION: IOPFF increases risk of stem revision and mortality up to ten years following surgery. The risk of revision depends on IOPFF subtype and mortality risk increases with subsequent revision surgery. Surgeons should carefully diagnose and treat IOPFF to minimize fracture progression and implant failure. Cite this article: Bone Joint J 2019;101-B:1199-1208.

Original publication




Journal article


Bone joint j

Publication Date





1199 - 1208


Calcar crack, Hip, IOPFF, Intraoperative fracture, Mortality, Shaft fracture, Stem revision, Trochanteric fracture, Age Factors, Aged, Arthroplasty, Replacement, Hip, Case-Control Studies, England, Female, Femoral Fractures, Follow-Up Studies, Humans, Male, Middle Aged, Multivariate Analysis, Northern Ireland, Osteoarthritis, Hip, Periprosthetic Fractures, Proportional Hazards Models, Registries, Reoperation, Retrospective Studies, Risk Assessment, Sex Factors, Time Factors, Treatment Outcome, United Kingdom, Wales