Constant Foissey1, Raymond Kenney2, Francesco Luceri3, Elvire Servien4,5, Sébastien Lustig4,6, Cécile Batailler4. 1. Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Center of Excellence, Croix-Rousse Hospital, 103 Grande rue de la Croix-Rousse, Rhône-Alpes, 69004, Lyon, France. constant.foissey@chu-lyon.fr. 2. Department of Orthopaedics, University of Rochester Medical Center, 4901 Lac De Ville Blvd Building D, Rochester, NY, 14618, USA. 3. Università Degli Studi Di Milano, Milan, Italy. 4. Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Center of Excellence, Croix-Rousse Hospital, 103 Grande rue de la Croix-Rousse, Rhône-Alpes, 69004, Lyon, France. 5. Interuniversity Laboratory of Human Movement Science-EA 7424, Université Lyon 1, Lyon, France. 6. Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France.
Abstract
INTRODUCTION: Greater trochanter (GT) fractures affect 0.6-29% of patients after direct anterior approach (DAA) total hip arthroplasty (THA). Given the growing popularity of this approach, this study aimed to assess the evolution of the GT fractures during the learning curve, their risk factors and their consequences. MATERIALS AND METHODS: 537 total hip arthroplasties were retrospectively included from May 2013 to December 2017 in a single academic centre. Patient characteristics, perioperative management, clinical consequences and postoperative radiographs were analysed. RESULTS: GT fractures represented 2.4% (n = 13) of the THA, and there was not a decrease with experience. The GT fracture patients did not require any additional support during the surgery, and full weight bearing was always allowed without any restriction. This complication only happened in females, with the risk significantly increased in those > 70 years old (OR = 4.9). There was no specific consequence during the follow-up, mean HHS score was 98.5 and all of the patients were satisfied or very satisfied postoperatively. CONCLUSION: Older osteoporotic women are known to be at risk for GT fracture during DAA THA. Those results reinforce the argument in favour of proper patient selection in DAA to lower the complications since it does not improve with surgeon's experience. LEVEL OF EVIDENCE: Retrospective, consecutive case series; Level IV.
INTRODUCTION: Greater trochanter (GT) fractures affect 0.6-29% of patients after direct anterior approach (DAA) total hip arthroplasty (THA). Given the growing popularity of this approach, this study aimed to assess the evolution of the GT fractures during the learning curve, their risk factors and their consequences. MATERIALS AND METHODS: 537 total hip arthroplasties were retrospectively included from May 2013 to December 2017 in a single academic centre. Patient characteristics, perioperative management, clinical consequences and postoperative radiographs were analysed. RESULTS: GT fractures represented 2.4% (n = 13) of the THA, and there was not a decrease with experience. The GT fracturepatients did not require any additional support during the surgery, and full weight bearing was always allowed without any restriction. This complication only happened in females, with the risk significantly increased in those > 70 years old (OR = 4.9). There was no specific consequence during the follow-up, mean HHS score was 98.5 and all of the patients were satisfied or very satisfied postoperatively. CONCLUSION: Older osteoporoticwomen are known to be at risk for GT fracture during DAA THA. Those results reinforce the argument in favour of proper patient selection in DAA to lower the complications since it does not improve with surgeon's experience. LEVEL OF EVIDENCE: Retrospective, consecutive case series; Level IV.
Entities:
Keywords:
Direct anterior approach; Femoral fracture; Greater trochanter; Risk factors; Total hip arthroplasty
Authors: S R Cummings; M C Nevitt; W S Browner; K Stone; K M Fox; K E Ensrud; J Cauley; D Black; T M Vogt Journal: N Engl J Med Date: 1995-03-23 Impact factor: 91.245