@article{Abdulhadi:2025:10.1302/2046-3758.141.bjr-2024-0134.r1,
author = {Abdulhadi, Alagha M and Cobb, J and Liddle, AD and Malchau, H and Rolfson, O and Mohaddes, M},
doi = {10.1302/2046-3758.141.bjr-2024-0134.r1},
journal = {Bone & Joint Research},
pages = {46--57},
title = {Prediction of implant failure risk due to periprosthetic femoral fracture after primary elective total hip arthroplasty},
url = {http://dx.doi.org/10.1302/2046-3758.141.bjr-2024-0134.r1},
volume = {14},
year = {2025}
}

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TY  - JOUR
AB  - <jats:sec><jats:title>Aims</jats:title><jats:p>While cementless fixation offers potential advantages over cemented fixation, such as a shorter operating time, concerns linger over its higher cost and increased risk of periprosthetic fractures. If the risk of fracture can be forecasted, it would aid the shared decision-making process related to cementless stems. Our study aimed to develop and validate predictive models of periprosthetic femoral fracture (PPFF) necessitating revision and reoperation after elective total hip arthroplasty (THA).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We included 154,519 primary elective THAs from the Swedish Arthroplasty Register (SAR), encompassing 21 patient-, surgical-, and implant-specific features, for model derivation and validation in predicting 30-day, 60-day, 90-day, and one-year revision and reoperation due to PPFF. Model performance was tested using the area under the curve (AUC), and feature importance was identified in the best-performing algorithm.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The Lasso regression excelled in predicting 30-day revisions (area under the receiver operating characteristic curve (AUC) = 0.85), while the Gradient Boosting Machine (GBM) model outperformed other models by a slight margin for all remaining endpoints (AUC range: 0.79 to 0.86). Predictive factors for revision and reoperation were identified, with patient features such as increasing age, higher American Society of Anesthesiologists grade (> III), and World Health Organization obesity classes II to III associated with elevated risks. A preoperative diagnosis of idiopathic necrosis increased revision risk. Concerning implant design, factors such as cementless femoral fixation, reverse-hybrid fixation, hip resurfacing, and small (< 35 mm) or large (> 52 mm) femoral head
AU  - Abdulhadi,Alagha M
AU  - Cobb,J
AU  - Liddle,AD
AU  - Malchau,H
AU  - Rolfson,O
AU  - Mohaddes,M
DO  - 10.1302/2046-3758.141.bjr-2024-0134.r1
EP  - 57
PY  - 2025///
SP  - 46
TI  - Prediction of implant failure risk due to periprosthetic femoral fracture after primary elective total hip arthroplasty
T2  - Bone & Joint Research
UR  - http://dx.doi.org/10.1302/2046-3758.141.bjr-2024-0134.r1
UR  - https://doi.org/10.1302/2046-3758.141.bjr-2024-0134.r1
VL  - 14
ER  - 

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