James M Hartford1, Sarah B Knowles2. 1. Department of Orthopaedic Surgery, Palo Alto Medical Foundation, Palo Alto, CA. 2. Palo Alto Medical Foundation Research Institute, Palo Alto, CA.
Abstract
BACKGROUND: With the increased popularity of the direct anterior approach, the issue of periprosthetic femur fractures has come into focus. The purpose of this article is to identify patient- and procedure-related characteristics that are associated with periprosthetic femur fractures in cementless total hip arthroplasties performed through a direct anterior approach using a fracture table. METHODS: Five hundred primary total hip arthroplasties performed using cementless femoral implants through a direct anterior approach using a fracture table were evaluated for characteristics associated with perioperative prosthetic femur fracture within the first 3 months of surgery. RESULTS: Twenty-three hips (4.6%) incurred fractures, 13 (2.6%) intraoperative and 10 (2.0%) postoperative. Bivariate analyses demonstrated females and a body mass index (BMI) >40 with a higher risk of fractures overall and postoperative fractures. A significant difference in DORR ratios was seen in patients with intraoperative fractures and a significant difference seen with implant sizes in patients with postoperative fractures. Multivariable regression analyses demonstrated an increased risk of postoperative fracture with a BMI >40. As the DORR ratio and implant size increased, there was a reduced odds of intraoperative fracture. CONCLUSION: Concern for periprosthetic femur fractures using the direct anterior approach for total hip arthroplasty is high in female patients and in patients with morbid obesity (BMI >40), small DORR ratio, or small implant size.
BACKGROUND: With the increased popularity of the direct anterior approach, the issue of periprosthetic femur fractures has come into focus. The purpose of this article is to identify patient- and procedure-related characteristics that are associated with periprosthetic femur fractures in cementless total hip arthroplasties performed through a direct anterior approach using a fracture table. METHODS: Five hundred primary total hip arthroplasties performed using cementless femoral implants through a direct anterior approach using a fracture table were evaluated for characteristics associated with perioperative prosthetic femur fracture within the first 3 months of surgery. RESULTS: Twenty-three hips (4.6%) incurred fractures, 13 (2.6%) intraoperative and 10 (2.0%) postoperative. Bivariate analyses demonstrated females and a body mass index (BMI) >40 with a higher risk of fractures overall and postoperative fractures. A significant difference in DORR ratios was seen in patients with intraoperative fractures and a significant difference seen with implant sizes in patients with postoperative fractures. Multivariable regression analyses demonstrated an increased risk of postoperative fracture with a BMI >40. As the DORR ratio and implant size increased, there was a reduced odds of intraoperative fracture. CONCLUSION: Concern for periprosthetic femur fractures using the direct anterior approach for total hip arthroplasty is high in female patients and in patients with morbid obesity (BMI >40), small DORR ratio, or small implant size.
Authors: Trevor R Gulbrandsen; Scott A Muffly; Alan Shamrock; Olivia O'Reilly; Nicolas A Bedard; Jesse E Otero; Timothy S Brown Journal: Iowa Orthop J Date: 2022-06