BACKGROUND: The direct anterior approach (DAA) for the treatment of total hip arthroplasty (THA) has gained popularity in recent years. Chip fractures of the greater trochanter are frequently seen, but the risk factors for such fractures are unknown. The study aimed to identify the risk factors for chip fractures in patients undergoing primary THA by the DAA during the surgeons' learning curve. MATERIALS AND METHODS: From November 2011 to April 2015, the first experiences of three surgeons who performed 120 THAs by the DAA (120 hips; 40 cases per beginner surgeon) were included. The incidence of chip fracture of the greater trochanter, the size of the greater trochanter as measured by computed tomography, and the patients' characteristics were retrospectively investigated. RESULTS: After exclusion of 11 hips, the remaining 109 hips were investigated. Chip fracture of the greater trochanter was identified in 32 hips (29.4 %). Univariate analysis with and without fractures showed that the width and depth of the greater trochanter were statistically significant risk factors (p = 0.02 and p < 0.001, respectively). Multivariate analysis using a logistic regression model demonstrated that the depth of the greater trochanter was an independent risk factor for chip fracture of the greater trochanter (OR 1.725; 95 % CI 1.367-2.177; p < 0.001). CONCLUSION: The size of the greater trochanter was identified as a risk factor for chip fracture of the greater trochanter. Novice surgeons should pay attention to the size of the greater trochanter when performing THA by the DAA.
BACKGROUND: The direct anterior approach (DAA) for the treatment of total hip arthroplasty (THA) has gained popularity in recent years. Chip fractures of the greater trochanter are frequently seen, but the risk factors for such fractures are unknown. The study aimed to identify the risk factors for chip fractures in patients undergoing primary THA by the DAA during the surgeons' learning curve. MATERIALS AND METHODS: From November 2011 to April 2015, the first experiences of three surgeons who performed 120 THAs by the DAA (120 hips; 40 cases per beginner surgeon) were included. The incidence of chip fracture of the greater trochanter, the size of the greater trochanter as measured by computed tomography, and the patients' characteristics were retrospectively investigated. RESULTS: After exclusion of 11 hips, the remaining 109 hips were investigated. Chip fracture of the greater trochanter was identified in 32 hips (29.4 %). Univariate analysis with and without fractures showed that the width and depth of the greater trochanter were statistically significant risk factors (p = 0.02 and p < 0.001, respectively). Multivariate analysis using a logistic regression model demonstrated that the depth of the greater trochanter was an independent risk factor for chip fracture of the greater trochanter (OR 1.725; 95 % CI 1.367-2.177; p < 0.001). CONCLUSION: The size of the greater trochanter was identified as a risk factor for chip fracture of the greater trochanter. Novice surgeons should pay attention to the size of the greater trochanter when performing THA by the DAA.
Entities:
Keywords:
Direct anterior approach; Femoral fracture; Greater trochanter; Learning curve
Authors: Matthew W Russo; J Ryan Macdonell; Megan C Paulus; Jarod M Keller; Mark W Zawadsky Journal: J Arthroplasty Date: 2015-03-17 Impact factor: 4.757
Authors: Marcel Haversath; Martin Lichetzki; Sebastian Serong; André Busch; Stefan Landgraeber; Marcus Jäger; Tjark Tassemeier Journal: Arch Orthop Trauma Surg Date: 2020-05-30 Impact factor: 3.067
Authors: Johannes Karl Maria Fakler; Alexander Brand; Christian Lycke; Christina Pempe; Mohamed Ghanem; Andreas Roth; Georg Osterhoff; Ulrich Josef Albert Spiegl; Andreas Höch; Dirk Zajonz Journal: Eur J Trauma Emerg Surg Date: 2020-12-11 Impact factor: 2.374