Abstract:The present study aimed to investigate the prevalence and clinical consequences of occult intra-operative periprosthetic femoral fractures in total hip arthroplasty (THA). Between 2012 and 2017, a total of 113 primary THAs were enrolled. The mean age of the patients was 66.4 ± 7.6 years. We assessed occult intra-operative periprosthetic femoral fractures with the use of computed tomography (CT) and risk factors, including age, sex, body mass index, diagnosis, stem size, and radiographic parameters of proximal … Show more
“…Scans were carried out with a helical CT scanner (Lightspeed VCT; GE Medical Systems, Milwaukee, Wisconsin, USA) to quantify the contact state of the implant and femur and to detect post-operative occult fracture – a post-THA complication. 16,17 Scans were carried out using a slice thickness of 1 mm and a pitch of 2.5 mm. All preoperative planning and post-operative evaluations were completed using a CT-based templating software ZedHip (Lexi Co, Tokyo, Japan).…”
Purpose: The mechanisms underlying thigh pain in patients with well-fixed cementless femoral components after total hip arthroplasty (THA) remains unclear. We hypothesized that the thigh pain is correlated with the initial contact state of the stem and aimed to investigate the relation between thigh pain and the initial contact state. Materials and methods: A total of 209 hips of 184 patients were analysed in this retrospective case–control study. The patients were divided into a thigh pain group ( n = 13 hips) and a control group (without thigh pain, n = 196). Post-operative stem contact images were three-dimensionally visualized by a density mapping function using computed tomography data, which quantified the stem contact area according to Gruen zones. Thigh pain was defined as anterior or anterolateral pain upon loading at 3-month post-operatively. Results: Thirteen hips (6.2%) had thigh pain; however, all the hips demonstrated stable bony ingrowth radiographically. The thigh pain group had a significantly lower contact area in zone 2 ( p = 0.014). The multivariate logistic regression analysis showed that the contact area of zone 2 was negatively correlated with thigh pain [odds ratio (OR): 0.858, p = 0.018], and the canal flare index was negatively correlated with the development of thigh pain (OR: 0.336, p = 0.026). Conclusions: We identified an association between the initial contact state and post-operative thigh pain. Our data demonstrated that proper lateral contact prevents the occurrence of thigh pain in THA using a tapered wedge stem.
“…Scans were carried out with a helical CT scanner (Lightspeed VCT; GE Medical Systems, Milwaukee, Wisconsin, USA) to quantify the contact state of the implant and femur and to detect post-operative occult fracture – a post-THA complication. 16,17 Scans were carried out using a slice thickness of 1 mm and a pitch of 2.5 mm. All preoperative planning and post-operative evaluations were completed using a CT-based templating software ZedHip (Lexi Co, Tokyo, Japan).…”
Purpose: The mechanisms underlying thigh pain in patients with well-fixed cementless femoral components after total hip arthroplasty (THA) remains unclear. We hypothesized that the thigh pain is correlated with the initial contact state of the stem and aimed to investigate the relation between thigh pain and the initial contact state. Materials and methods: A total of 209 hips of 184 patients were analysed in this retrospective case–control study. The patients were divided into a thigh pain group ( n = 13 hips) and a control group (without thigh pain, n = 196). Post-operative stem contact images were three-dimensionally visualized by a density mapping function using computed tomography data, which quantified the stem contact area according to Gruen zones. Thigh pain was defined as anterior or anterolateral pain upon loading at 3-month post-operatively. Results: Thirteen hips (6.2%) had thigh pain; however, all the hips demonstrated stable bony ingrowth radiographically. The thigh pain group had a significantly lower contact area in zone 2 ( p = 0.014). The multivariate logistic regression analysis showed that the contact area of zone 2 was negatively correlated with thigh pain [odds ratio (OR): 0.858, p = 0.018], and the canal flare index was negatively correlated with the development of thigh pain (OR: 0.336, p = 0.026). Conclusions: We identified an association between the initial contact state and post-operative thigh pain. Our data demonstrated that proper lateral contact prevents the occurrence of thigh pain in THA using a tapered wedge stem.
“…In addition, biomechanical data show that addition of a stem collar decreases the incidence of periprosthetic fractures. 17–20 These data suggest that femoral press fit stems with simple proximal geometry and selection of collared stems are the surgeon-controlled variable that can decrease fracture risk. Stem design however must be coupled with a good surgical technique.…”
“…26 Studies have also reported an increased rate of occult femoral IPPFx with double-tapered stems with a proximal and distal trapezoidal and quadrangular cross-section, respectively. 27 However, shorter cementless reduced femoral geometry stems have been shown to decrease fracture risk. 26 Femoral IPPFx can occur during both stem broaching and final component impaction.…”
Section: Implant Factorsmentioning
confidence: 99%
“…In this article, reference 42 is level II studies. References 2,3,4,5,6,7,8,9,10,11,13,15,16,18,19,20,21,22,26,27,28,33,41,43,45,47,48, and 49 are level III studies. References 14,23,30,34,44, and 46 are level IV studies.…”
Intraoperative periprosthetic fractures are challenging complications that may affect implant stability and survivorship. Periprosthetic acetabular fractures are uncommon and infrequently are the focus of studies. Acetabular fractures are occasionally recognized after patients report unremitting groin pain weeks postoperatively. The widespread use of cementless acetabular cups might lead to higher number of fractures than is clinically detectable. Conversely, the incidence of intraoperative periprosthetic femoral fractures are more common and encompass a broad spectrum, ranging from a small cortical perforation to displaced fractures with an unstable prosthesis. Appropriate recognition, including mindfulness of preoperative patient and surgical risk factors, is critical to the successful management of acetabular and femoral complications. This comprehensive review article focuses on the incidence, patient and surgical risk factors, diagnosis, management, and clinical outcomes associated with intraoperative acetabular and femur fractures in primary total hip arthroplasty.
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