Low risk of periprosthetic fracture and subsidence with automated impaction device in arthroplasty following femoral neck fracture: A retrospective study.

Abstract

Manual broaching in hip arthroplasty for femoral neck fractures (FNFx) may introduce variability in force application, increasing the risk of periprosthetic fractures. Automated impaction devices (AID) deliver consistent, uniform force vectors during femoral preparation, potentially reducing implant-bone mismatch, stem subsidence, and fracture risk. This study evaluates early complication rates following AID use in hip arthroplasty for FNFx. A retrospective cohort study was conducted on consecutive patients undergoing total hip arthroplasty (THA) or hemiarthroplasty (HA) for FNFx by two surgeons between January 1, 2019, and June 1, 2023. All patients received a cementless femoral stem implanted with an AID and had a minimum 30-day follow-up. Outcomes assessed included 30-day revision-free stem survivorship, intraoperative and postoperative periprosthetic fractures, femoral component subsidence, and 30-day reoperation and readmission rates. The cohort included 118 patients [72.0 % women; mean age 77.4 (range, 52-95) years], with 82 (69.5 %) undergoing THA and 36 (30.5 %) HA. One intraoperative fracture (0.8 %, Vancouver AG) and one postoperative fracture (0.8 %, Vancouver B1) occurred. The 30-day reoperation rate was 3.4 % (n = 4), and the readmission rate was 16.3 % (n = 15). Mild femoral component subsidence occurred in 1.7 % (n = 2) without evidence of loosening. No femoral stem revisions were reported within 30 days, yielding a 100 % short-term survivorship rate. Early outcomes suggest that AID use in hip arthroplasty for FNFx is associated with low rates of periprosthetic fracture, subsidence, and early complications. Further prospective studies are needed to assess long-term outcomes.