{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T02:21:55Z","timestamp":1786674115739,"version":"build-2736575974"},"reference-count":61,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"2","license":[{"start":{"date-parts":[[2011,2,1]],"date-time":"2011-02-01T00:00:00Z","timestamp":1296518400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery. British volume"],"published-print":{"date-parts":[[2011,2]]},"abstract":"<jats:p> Peri-prosthetic femoral fracture after total hip replacement (THR) is associated with a poor outcome and high mortality. However, little is known about its long-term incidence after uncemented THR. <\/jats:p><jats:p> We retrospectively reviewed a consecutive series of 326 patients (354 hips) who had received a CLS Spotorno replacement with an uncemented, straight, collarless tapered titanium stem between January 1985 and December 1989. The mean follow-up was 17 years (15 to 20). The occurrence of peri-prosthetic femoral fracture during follow-up was noted. Kaplan-Meier survival analysis was used to estimate the cumulative incidence of fracture. <\/jats:p><jats:p> At the last follow-up, 86 patients (89 hips) had died and eight patients (eight hips) had been lost to follow-up. A total of 14 fractures in 14 patients had occurred. In ten hips, the femoral component had to be revised and in four the fracture was treated by open reduction and internal fixation. The cumulative incidence of peri-prosthetic femoral fracture was 1.6% (95% confidence interval 0.7 to 3.8) at ten years and 4.5% (95% confidence interval 2.6 to 8.0) at 17 years after the primary THR. There was no association between the occurrence of fracture and gender or age at the time of the primary replacement. <\/jats:p><jats:p> Our findings indicate that peri-prosthetic femoral fracture is a significant mode of failure in the long term after the insertion of an uncemented CLS Spotorno stem. Revision rates for this fracture rise in the second decade. Further research is required to investigate the risk factors involved in the occurrence of late peri-prosthetic femoral fracture after the implantation of any uncemented stem, and to assess possible methods of prevention. <\/jats:p>","DOI":"10.1302\/0301-620x.93b2.24329","type":"journal-article","created":{"date-parts":[[2011,2,1]],"date-time":"2011-02-01T00:15:08Z","timestamp":1296519308000},"page":"178-183","source":"Crossref","is-referenced-by-count":46,"title":["Late peri-prosthetic femoral fracture as a major mode of failure in uncemented primary hip replacement"],"prefix":"10.1302","volume":"93-B","author":[{"given":"M. R.","family":"Streit","sequence":"first","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Merle","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Clarius","sequence":"additional","affiliation":[{"name":"Hospital for Orthopaedic and Trauma Surgery, Vulpiusklinik, Vulpiusstrasse 29, 74906 Bad Rappenau, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. R.","family":"Aldinger","sequence":"additional","affiliation":[{"name":"Orthop\u00e4dische Klinik Paulinenhilfe, Diakonieklinikum, Rosenbergstrasse 38, 70192 Stuttgart, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"R1","unstructured":"Lewallen DG, Berry DJ. Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date. Instr Course Lect 1998;47:243\u20139."},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-5898(05)70078-X"},{"key":"R3","unstructured":"Laffargue P, Soenen M, Pinoit Y, Migaud H. Periprosthetic fractures around total hip and knee arthroplasty: mortality, morbidity and prognostic factors of periprosthetic femoral fractures following hip arthroplasty: multicentric prospective assessment of 115 cases. Rev Chir Orthop Reparatrice Appar Mot 2006;92(Suppl2)):64\u20139 (in French)."},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2007.01.003"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1080\/17453670710015463"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2010.01.102"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-5898(03)00077-4"},{"key":"R8","doi-asserted-by":"crossref","unstructured":"Bhattacharyya T, Chang D, Meigs JB, Estok DM 2nd, Malchau H. Mortality after periprosthetic fracture of the femur. J Bone Joint Surg [Am] 2007;89-A:2658\u201362.","DOI":"10.2106\/JBJS.F.01538"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-5898(05)70073-0"},{"key":"R10","doi-asserted-by":"crossref","unstructured":"Lindahl H, Garellick G, Regn\u00e9r H, Herberts P, Malchau H. Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg [Am] 2006;88-A:1215\u201322.","DOI":"10.2106\/JBJS.E.00457"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2003.50109"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.93B1.25087"},{"key":"R13","unstructured":"DeFrances CJ, Hall MJ. 2002 National Hospital Discharge Survey. Adv Data 2004;342:1\u201329."},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2007.02.048"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-008-0289-1"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1007\/BF00934256"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1016\/0883-5403(92)90035-O"},{"key":"R18","doi-asserted-by":"crossref","unstructured":"Crockarell JR Jr, Berry DJ, Lewallen DG. Nonunion after periprosthetic femoral fracture associated with total hip arthroplasty. J Bone Joint Surg [Am] 1999;81-A:1073\u20139.","DOI":"10.2106\/00004623-199908000-00003"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1080\/000164700317393321"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1080\/000164700317381081"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-003-0493-2"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2005.02.001"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-009-0906-7"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.92B8.23123"},{"key":"R25","doi-asserted-by":"crossref","unstructured":"Aldinger PR, Jung AW, Pritsch M, et al. Uncemented grit-blasted straight tapered titanium stems in patients younger than fifty-five years of age: fifteen to twenty-year results. J Bone Joint Surg [Am] 2009;91-A:1432\u20139.","DOI":"10.2106\/JBJS.H.00297"},{"key":"R26","unstructured":"Wu CC, Au MK, Wu SS, Lin LC. Risk factors for postoperative femoral fracture in cementless hip arthroplasty. J Formos Med Assoc 1999;98:190\u20134."},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2007.02.049"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2004.07.023"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2010.501748"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.82B8.0821151"},{"key":"R31","doi-asserted-by":"crossref","unstructured":"Singh M, Nagrath AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg [Am] 1970;52-A:457\u201367.","DOI":"10.2106\/00004623-197052030-00005"},{"key":"R32","unstructured":"Spotorno L, Romagnoli S, Ivaldo N, et al. The CLS system: theoretical concept and results. Acta Orthop Belg 1993;59(Suppl 1):144\u20138."},{"key":"R33","doi-asserted-by":"crossref","unstructured":"Vicar AJ, Coleman CR. A comparison of the anterolateral, transtrochanteric and posterior surgical approaches in primary total hip arthroplasty. Clin Orthop 1984;188:152\u20139.","DOI":"10.1097\/00003086-198409000-00019"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.1007\/BF00379169"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2007.04.002"},{"key":"R36","doi-asserted-by":"crossref","unstructured":"Garcia-Cimbrelo E, Cruz-Pardos A, Madero R, Ortega-Andreu M. Total hip arthroplasty with use of the cementless Zweymuller Alloclassic system: a ten to thirteen-year follow-up study. J Bone Joint Surg [Am] 2003;85-A:296\u2013303.","DOI":"10.2106\/00004623-200302000-00017"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-5898(05)70076-6"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.1016\/S0883-5403(00)91181-1"},{"key":"R39","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5402.177"},{"key":"R40","unstructured":"No authors listed. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. 2000. http:\/\/web.archive.org\/web\/20071027224123\/www.wma.net\/e\/policy\/pdf\/17c.pdf (date last accessed 23 December 2010)."},{"key":"R41","doi-asserted-by":"publisher","DOI":"10.3109\/17453678709146336"},{"key":"R42","doi-asserted-by":"crossref","unstructured":"Kavanagh BF. Femoral fractures associated with total hip arthroplasty. Orthop Clin North Am 1992;23:249\u201357.","DOI":"10.1016\/S0030-5898(20)31735-1"},{"key":"R43","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199606000-00029"},{"key":"R44","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-1383(02)00257-7"},{"key":"R45","doi-asserted-by":"crossref","unstructured":"Beathea JS 3rd, DeAndrade JR, Fleming LL, Lindenbaum SD, Welch RB. Proximal femoral fractures following total hip arthroplasty. Clin Orthop 1982;170:95\u2013106.","DOI":"10.1097\/00003086-198210000-00013"},{"key":"R46","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-009-1034-0"},{"key":"R47","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.86B1.14864"},{"key":"R48","doi-asserted-by":"publisher","DOI":"10.1080\/17453670510041538"},{"key":"R49","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-199405000-00005"},{"key":"R50","unstructured":"Lindahl H. The periprosthetic femur fracture: a study from the Swedish National Hip Arthroplasty Register [Abstract]. http:\/\/gupea.ub.gu.se\/handle\/2077\/16831?locale=en (date last accessed 26 October 2010)."},{"key":"R51","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.66B3.6725341"},{"key":"R52","doi-asserted-by":"publisher","DOI":"10.1080\/00016470510030328"},{"key":"R53","doi-asserted-by":"crossref","unstructured":"Robinson CM, Adams CI, Craig M, et al. Implant-related fractures of the femur following hip fracture surgery. J Bone Joint Surg [Am] 2002;84-A:1116\u201322.","DOI":"10.2106\/00004623-200207000-00004"},{"key":"R54","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-0690(18)30920-0"},{"key":"R55","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198812293192604"},{"key":"R56","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/17.6.365"},{"key":"R57","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/44.4.M112"},{"key":"R58","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/6.4.201"},{"key":"R59","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1987.tb04341.x"},{"key":"R60","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(90)90110-B"},{"key":"R61","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/18.1.47"}],"container-title":["The Journal of Bone and Joint Surgery. British volume"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.93B2.24329","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/full-xml\/10.1302\/0301-620X.93B2.24329","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.93B2.24329","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T18:55:09Z","timestamp":1629140109000},"score":1,"resource":{"primary":{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/10.1302\/0301-620X.93B2.24329"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,2]]},"references-count":61,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2011,2]]}},"alternative-id":["10.1302\/0301-620X.93B2.24329"],"URL":"https:\/\/doi.org\/10.1302\/0301-620x.93b2.24329","relation":{},"ISSN":["0301-620X","2044-5377"],"issn-type":[{"value":"0301-620X","type":"print"},{"value":"2044-5377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,2]]}}}