Risk Factors of Femoral Fractures in Lateral Decubitus Direct Anterior Approach Total Hip Arthroplasty Using Conventional Stem: A Retrospective Analysis

Abstract

Objective: In order to provide guideline to operation and reduce the incidence of fractures, this study analyze the relationship between femoral fractures and related factors in direct anterior approach (DAA) total hip arthroplasty (THA) in lateral decubitus position. Method: A consecutive retrospective series of 273 THA by DAA in lateral decubitus position were analyzed. The surgery were performed by the same surgeon with conventional operation bed and femoral stem. The correlations between incidence of fractures with gender, age, body mass index (BMI), height, osteoporosis, anterior superior iliac spine-greater trochanter distance (ASIS-GTD), and hip-joint diseases were analyzed by univariate analysis and logistic regression analysis. Results: Among all hip arthroplasty, 34 cases had femoral fractures, including 29 greater trochanter fractures, 4 proximal femoral splits and 1 femoral perforation. The incidence of fractures was 13.03%. Univariate analysis: the discrepancies in incidence of fractures among genders, BMIs and age were not significant different; osteoporosis caused an increase of fractures; the incidence of fractures declined as height, ASIS-GTD increased; The incidence of femoral neck fracture and osteonecrosis of femoral head was lower than others. Logistic regression results: there was a significant correlation between osteoporosis, ASIS-GTD and fractures. Patients with osteoporosis had a high possibility of fractures (OR=2.353); the possibility of fractures decreased with an upward ASIS-GTD(OR=0.939). Conclusion: The lateral decubitus DAA THA can be successfully performed using conventional operation bed and stem, which saved medical resources effectively. Osteoporosis and ASIS-GTD were independent risk factors for femoral fractures; Short stature, inflammatory arthroses were relatively risk factors.