FP12.5 Long-Term Periprosthetic Fracture Risk After Hip Resurfacing Arthroplasty: A 25-Year Analysis Supporting Femoral Neck Preservation
Abstract
Abstract ICLA12 - The Chondral Masterclass: Advanced Scaffolds, Orthobiologic Realities, and Young THA, Auditorium B (BMCC Level 1), October 9, 2026, 10:30 - 12:30 Introduction Femoral neck fracture (FNF) is the most common early failure mode in hip resurfacing arthroplasty (HRA). However, there are concerns that preserving the native femoral neck may leave aging patients uniquely vulnerable to late fracture. Whether femoral stem implantation in total hip arthroplasty (THA) is protective or instead predisposes patients to periprosthetic fracture remains unknown. This study defines the incidence, timing, and risk factors for all periprosthetic fractures following HRA over 25 years and benchmarks findings against published THA data. Methods A prospectively maintained database of 7715 consecutive metal-on-metal HRAs performed between 2001 and 2023 was retrospectively reviewed. Fractures were classified as early (≤6 months) or late (>6 months) by type and fixation method (cemented vs. uncemented). Demographics including sex, age, body mass index (BMI), and bone mineral density (BMD) were compared between fracture and non-fracture cohorts. Kaplan-Meier (KM) survival used revision or reoperation for fracture as the endpoint. Results One hundred ten fractures occurred over 25 years (1.4% overall). Early fractures (43%) were predominantly femoral neck stress fractures (68.1%). Late fractures were rare: femoral head (0.5%), trochanteric (0.1%), femoral neck (0.1%). KM survival was 98.6% at 20 years and 97.5% at 25 years; the uncemented cohort showed 99.1% survival at 18 years. Fracture patients were more frequently female (40.0% vs. 29.1%, p=0.013), older (56.5 vs. 53.9 years, p=0.01), and had lower BMD (T-score −0.7 vs. −0.1, p<0.0001). Conclusion Femoral neck preservation in HRA does not increase long-term fracture risk. Periprosthetic fracture rates were substantially lower than published THA benchmarks over 25 years. Early failures were stress-related and manageable; late failures were rare and typically traumatic. Femoral stem implantation may itself predispose to periprosthetic fracture.