Intraoperative Proximal Femoral Fracture in Primary Cementless Total Hip Arthroplasty

Ponzio, Danielle Y.; Shahi, Alisina; Park, Andrew G.; Purtill, James J.

doi:10.1016/j.arth.2015.02.043

Cited by 50 publications

(41 citation statements)

References 11 publications

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“…Intraoperative proximal femoral fracture was defined as a nondisplaced incomplete linear fracture above the lesser trochanter. 6 Of the 24 fractures, 9 occurred in male patients and 15 occurred in female patients, none of whom had bilateral THA. All proximal femoral fractures occurred during impaction of the final femoral component rather than during reaming or broaching of the canal or during trial reduction.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Intraoperative Proximal Femoral Fracture During Primary Cementless THA

Zhao¹,

Cai²,

Liu³

et al. 2017

Orthopedics

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Intraoperative proximal femoral fracture, one of the most common complications of total hip arthroplasty (THA), occurs more often in cementless procedures and can affect rehabilitation, hospitalization time, and cost of treatment. The goal of this study was to identify risk factors for intraoperative proximal femoral fracture in THA to identify high-risk groups preoperatively and minimize the incidence of this complication. This nested case-control study included 904 primary cementless THA procedures (769 patients) performed between January 2009 and July 2015. Of this group, 24 fractures occurred, accounting for 2.65% of cases. Predisposing factors for intraoperative proximal femoral fracture from the medical records included patient sex, diagnosis of osteoarthritis, operated on hip (left or right), type of implant, alcohol consumption, operative approach, age, and body mass index. The Noble classification, Dorr classification, and Metaphyseal-Diaphyseal Index score measured by picture archiving and communication systems were used to evaluate the anatomy and morphologic features of the proximal femur. A multivariate analysis was performed to evaluate potential risk factors for fracture during THA, including anterolateral (modified Hardinge) approach, use of the Corail (DePuy, Warsaw, Indiana) stem, Metaphyseal-Diaphyseal Index score, age, and sex. A Corail stem, the anterolateral approach, advanced age, and a low Metaphyseal-Diaphyseal Index score were associated with increased risk of fracture. All fractures were treated with cerclage wire techniques, and none has required revision to date. [Orthopedics. 2017; 40(2):e281-e287.].

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Section: Methodsmentioning

confidence: 99%

Risk Factors for Intraoperative Proximal Femoral Fracture During Primary Cementless THA

Zhao¹,

Cai²,

Liu³

et al. 2017

Orthopedics

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“…The dominant reasons for revision are mechanical in nature and involve instability, loosening, and periprosthetic fracture . Compromised stability as well as bone fracture may be directly related to the mechanisms of press‐fitting an uncemented implant in the bone and could become increasingly critical in aging patients with poor quality bone stock, in both primary and revision cases …”

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confidence: 99%

“…3,14,15 Compromised stability as well as bone fracture may be directly related to the mechanisms of press-fitting an uncemented implant in the bone and could become increasingly critical in aging patients with poor quality bone stock, in both primary and revision cases. 14,[16][17][18][19][20] Press-fit stability relies on the generation of radial (normal) contact stresses to develop frictional (shear) resistance to relative motion between implant and bone. [21][22][23] The radial contact stresses must be resisted by radial and circumferential stressing of the trabecular and cortical bone, which can consequently crush or fracture.…”

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confidence: 99%

Influence of trabecular bone quality and implantation direction on press‐fit mechanics

Damm

Morlock

Bishop

2016

Journal Orthopaedic Research

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Achieving primary stability of uncemented press-fit prostheses in patients with poor quality bone can involve axial implantation forces large enough to cause bone fracture. Radial implantation eliminates intraoperative impaction forces and could prevent this damage. Platens of two commercial implant surfaces ("Beaded" and "Flaked") were implanted onto trabecular bone specimens of varying quality in a press-fit simulator. Samples were implanted with varying interference, either axially (shear) or radially (normal). Push-in and pull-out forces were measured to assess stability. Microstructural changes in the bone were determined from μCT analysis. For force-defined implantation analysis, push-in and pull-out forces both increased proportionally with increasing radial force, independent of implantation direction, bone quality or implant surface. For position-defined implantation analysis, pull-out forces were generally found to increase with interference and to be greater for radial than axial implantation direction, and to be lower for poor quality bone. Bone density increased locally at the tested interface due to implantation, in particular for the Beaded surface under axial implantation. If a safe radial stress can be determined for cortical bone in a particular patient, the associated implantation force, and pull-out force which represents primary stability, can be directly derived, regardless of implantation direction, bone quality or implant surface. Radial implantation delivers primary stability that is no worse than that for axial implantation and may eliminate potentially damaging impaction forces. Development of implant designs based on this principal might improve implant fixation. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:224-233, 2017.

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“…[80,81] However, the present study demonstrated an incidence of 1.4%, which is lower than the 2.95-10.6% reported in other large series. [82][83][84][85] The three intraoperative fractures in the present series were all treated successfully using cerclage cables inserted through a smaller secondary incision without compromising the short external rotators. The only other complication attributable to decreased visualization was a return to the OR from PACU after a postoperative radiograph demonstrated a previously unrecognized piece of bone interposed between the prosthetic head and cup.…”

Section: Discussionmentioning

confidence: 72%

Two Year Average Follow Up of Supercapsular Percutaneously Assisted Total Hip Arthroplasty; Zero Dislocations

Kay¹,

Klavas²,

Haghshenas³

et al. 2020

Preprint

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BACKGROUNDDislocation after primary total hip arthroplasty (THA) has an incidence of 2-3. Approximately 77% of dislocations occur within the first year after surgery. The SuperPATH technique is a minimally invasive approach for THA that preserves soft tissue attachments. The purpose of this study is to describe the dislocation rate at one year after SuperPATH primary THA. METHODSAll elective primary THAs performed by the senior author using the SuperPATH approach. Exclusion criteria were acute femoral neck fracture, revision surgery, or malignancy. There were 214 of 279 eligible patients available for telephone interviews (76.7%). Medical records were reviewed for secondary outcomes including early and late complications, cup positioning, distance ambulated on postoperative day one, discharge destination, and blood transfusions. RESULTSMean age at surgery was 64 ± 10.8 years and mean time to telephone follow up was 773 ± 269.7 days. There were 104 female and 110 male patients. There were zero dislocations reported. Blood transfusions were performed in 3.7% of patients, and 75.7% were discharged to home at an average of 2.3 ± 1.0 days. Cup position averaged 43.6 ± 5.2° abduction and 20.9 ± 6.2° anteversion, with an average leg length discrepancy of 3.6 ± 3.32mm. Complications included three intraoperative calcar fractures, one periprosthetic femur fracture, one early femoral revision, three superficial infections, and one instance of wound necrosis.CONCLUSIONSuperPATH approach is safe for use in primary THA resulting in a low dislocation rate.

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Intraoperative Proximal Femoral Fracture in Primary Cementless Total Hip Arthroplasty

Cited by 50 publications

References 11 publications

Risk Factors for Intraoperative Proximal Femoral Fracture During Primary Cementless THA

Risk Factors for Intraoperative Proximal Femoral Fracture During Primary Cementless THA

Influence of trabecular bone quality and implantation direction on press‐fit mechanics

Two Year Average Follow Up of Supercapsular Percutaneously Assisted Total Hip Arthroplasty; Zero Dislocations

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