Intraoperative Femur Fracture Risk During Primary Direct Anterior Approach Cementless Total Hip Arthroplasty With and Without a Fracture Table

Cohen, Eric; Vaughn, Joshua; Ritterman, Scott A.; Eisenson, Daniel; Rubin, Lee E.

doi:10.1016/j.arth.2017.04.020

Cited by 41 publications

(16 citation statements)

References 13 publications

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“…Cortical perforations and fracture are known risks of direct anterior hip replacement surgery. Female patients with poor bone quality are at higher risk of these complications [1]. Aberrant femoral anatomy secondary to developmental dysplasia or a low femoral cortex-to-canal ratio should raise caution during the preoperative planning period [4].…”

Section: Discussionmentioning

confidence: 99%

“…Morbid obesity can also increase the risk of intraoperative fracture and malpositioning of components because of soft-tissue constraints [11]. Several studies noted cortical perforations tend to occur early in the initial phases of adopting the direct anterior approach [1,2,5,11]. Masonis et al [2] demonstrated all direct anterior approach complications decline after the first 100 cases.…”

Section: Discussionmentioning

confidence: 99%

“…This minimally invasive approach presents a different view of the proximal femoral anatomy where appropriate soft-tissue and capsular releases are necessary to enhance exposure to successfully perform hip arthroplasty. Studies have demonstrated intraoperative femoral fractures during the direct anterior approach range from 0.8% to 7% for primary cases [1][2][3][4]. A simple femoral cortex perforation can lead to fracture propagation if not properly identified intraoperatively.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Novel Technique to Detect Femoral Shaft Perforation during Direct Anterior Total Hip Arthroplasty

Fravel¹,

Deskins²,

Kocher³

et al. 2020

Arthroplasty Today

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Despite its popularity, the direct anterior approach for hip arthroplasty is not without complications. Intraoperative femoral shaft perforation using this approach ranges from 0.8% to 7%. A missed perforation can lead to fracture with the need for further surgery if not detected intraoperatively. We describe a reproducible and cost-effective technique using a plastic Yankauer suction handle to help identify proximal femoral perforations during direct anterior total hip arthroplasty. Careful attention to the visual, tactile, and auditory feedback provided by the suction handle can help ensure the cortical continuity of the proximal femur. Familiarity with relevant surgical anatomy, improving surgical technique, and scrutinizing implant positioning helps minimize the risk of complications during the direct anterior approach.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Novel Technique to Detect Femoral Shaft Perforation during Direct Anterior Total Hip Arthroplasty

Fravel¹,

Deskins²,

Kocher³

et al. 2020

Arthroplasty Today

View full text Add to dashboard Cite

show abstract

“…The incidence of intraoperative periprosthetic fractures during total hip arthroplasty (THA) are becoming more common given the increased use of cementless femoral stem fixation,1 which may cause bursting of the femur required to achieve a press-fit and intimate contact with the bone 2. Plain radiographs have been mostly used to evaluate the pre and postoperative general status of THA patients including to detect periprosthetic fractures due to their simplicity, availability, and minimal expense.…”

Section: Introductionmentioning

confidence: 99%

Differentiating Nutrient Artery Canals of the Femur versus Fracture Lines in Patients with Total Hip Arthroplasty on Plain Radiographs

Yun

Choi

Kim

et al. 2019

IJOO

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Background: Nutrient artery canals of the femur are often visible on plain radiographs as radiolucent lines which may mimic fracture lines. The purpose of this study was to distinguish nutrient artery canals from fracture lines on plain radiographs. Materials and Methods: Ninety-three patients (102 hips) with an average age of 65.6 years were included in the study. We retrospectively analyzed nutrient artery canals of the femur on pre and postoperative anteroposterior (AP) and cross-table lateral (CTL) hip radiographs in patients with cementless total hip arthroplasty. The shape, number, location, direction of obliquity, length of nutrient artery canal, and the distance between the tip of the greater trochanter and the proximal end of the nutrient artery canal were measured. Results: Nutrient artery canals were determined in 54 hips (53.0%) on preoperative radiographs. The numbers of nutrient artery canals were entirely found to be one for each hip. The nutrient artery canals of the femur were the most frequently seen in the cortex on CTL radiographs with 32 hips (31.4%), whereas nutrient artery canals were not seen at all in the cortex on AP radiographs. All nutrient artery canals in the cortex on CTL radiographs coursed upward obliquely. Comparing to fracture lines, nutrient artery canals show less radiolucency, smaller diameter, and blunted ends in both the cortex and medullary cavity, show sclerotic walls in the cortex and have the less straight course in the medullary cavity. Conclusions: Based on the results of this study, there are clearly distinguishable differences between nutrient artery canals of the femur and fracture lines on plain radiographs.

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“…Joint replacement surgery is one of the greatest techniques used nowadays for severe joint damage and advanced osteoarthritis. The damaged tissue is partially or totally removed, then replaced with an artificial joint, such as a metal shell (titanium, stainless steel), a polymer component, such as polyethylene, or a metal rod . However, revision surgery often becomes a necessity, in addition to the various types of complications, including infections, loosening of the artificial joint, implant abrasion, and osteolysis …”

Section: Introductionmentioning

confidence: 99%

Surface treatment with amino acids of porous collagen based scaffolds to improve cell adhesion and proliferation

et al. 2018

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The purpose of this study was to improve the biocompatibility of glutaraldehyde (GA) cross‐linked chitosan coated collagen scaffold for cartilage tissue regeneration. In order to prevent the potential toxicity of GA, we treated the designed scaffold with either glutamic acid or glycine. Amino acid treated scaffolds were characterized by scanning electron microscopy (SEM) techniques. Afterward, chondrocyte interaction with the composite scaffold was investigated assessing cell adhesion and proliferation using Hoechst staining and MTT cell proliferation assay, respectively. The SEM analyses of the scaffolds’ surface and cross‐section confirmed the adhesion of amino acids on the surface of the scaffolds. We also observed that scaffolds’ porosity was reduced due to the coverage of the pores by chitosan and amino acids, leading to low porosity. The use of amino acid improved the chondrocyte adhesion and proliferation inside the scaffolds’ pores when cells were cultured onto the chitosan‐coated collagen scaffolds. Overall, our in vitro results suggest the use of amino acid to improve the biocompatibility of natural polymer composite scaffold being crosslinked with glutaraldehyde. Such scaffold has improved mechanical properties; biocompatibility thus may be useful for tissue regeneration such as cartilage.

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Intraoperative Femur Fracture Risk During Primary Direct Anterior Approach Cementless Total Hip Arthroplasty With and Without a Fracture Table

Cited by 41 publications

References 13 publications

A Novel Technique to Detect Femoral Shaft Perforation during Direct Anterior Total Hip Arthroplasty

A Novel Technique to Detect Femoral Shaft Perforation during Direct Anterior Total Hip Arthroplasty

Differentiating Nutrient Artery Canals of the Femur versus Fracture Lines in Patients with Total Hip Arthroplasty on Plain Radiographs

Surface treatment with amino acids of porous collagen based scaffolds to improve cell adhesion and proliferation

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