Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty

Abstract

Background and purpose — Intraoperative periprosthetic femoral fracture is a known complication of cementless total hip arthroplasty (THA). We determined the incidence of—and risk factors for—intraoperative calcar fracture, and assessed its influence on the risk of revision.Patients and methods — This retrospective analysis included 3,207 cementless THAs (in 2,913 patients). 118 intraoperative calcar fractures were observed in these hips (3.7%). A control group of 118 patients/hips without calcar fractures was randomly selected. The mean follow-up was 4.2 (1.8–8.0) years. Demographic data, surgical data, type of implant, and proximal femur morphology were evaluated to determine risk factors for intraoperative calcar fracture.Results — The revision rates in the calcar fracture group and the control group were 10% (95% CI: 5.9–17) and 3.4% (CI: 1.3–8.4), respectively. The revision rate directly related to intraoperative calcar fracture was 7.6%. The Hardinge approach and lower age were risk factors for calcar fracture. In the fracture group, 55 of 118 patients (47%) had at least one risk factor, while only 23 of118 patients in the control group (20%) had a risk factor (p = 0.001). Radiological analysis showed that in the calcar fracture group, there were more deviated femoral anatomies and proximal femur bone cortices were thinner.Interpretation — Intraoperative calcar fracture increased the risk of revision. The Hardinge approach and lower age were risk factors for intraoperative calcar fracture. To avoid intraoperative fractures, special attention should be paid when cementless stems are used with deviant-shaped proximal femurs and with thin cortices.

Effect of stem sizing and position on short‐term complications with canine press fit cementless total hip arthroplasty

“…Due to the relatively small incidence of complications or major subsidence, the influence of age and weight may have been under appreciated. Poor bone quality and thin femoral cortices have also been identified as risk factors, for THA complications in human patients . The influence of these factors remain unclear in dogs, although cortical bone thickness and quality of cancellous bone are intrinsic to implant stability.…”

Total hip arthroplasty

“…These fractures are associated with a poor clinical outcome and functional recovery and a high mortality rate. 28 , 29 Their incidence appears to be increasing as a result of increasing patient longevity, more demanding activity levels that persist into advanced age, and increasing rate of revision THA due to patients’ increased life expectancy. Risk factors for intra-operative fractures are osteoporosis, rheumatoid arthritis, femoral preparation and surgical rasping technique, press-fit cementless stems and revision THA.…”

“…Risk factors for intra-operative fractures are osteoporosis, rheumatoid arthritis, femoral preparation and surgical rasping technique, press-fit cementless stems and revision THA. 28 , 29 Risk factors for post-operative fractures are advanced age, female gender, post-traumatic osteoarthritis, osteoporosis, rheumatoid arthritis, proximal femoral deformities, previous hip surgery, type of implant and fixation, technical errors (cortical perforation and stress risers), low-energy trauma, osteolysis, loosening and revision THA. 28 , 29 …”

Risk Factors for Intraoperative Periprosthetic Femoral Fractures During Primary Total Hip Arthroplasty. An Analysis From the National Joint Registry for England and Wales and the Isle of Man

“…Large strains can occur when the surgeon establishes implant stability through press-fit fixation with cementless femoral implants [6], which increases the risk of IOPFF with cementless femoral implants [2,3,7]. IOPFF has been linked to an increased risk of post-operative periprosthetic fracture (PFF) and increased revision risk [2,8,9]. Reduced implant survival in cementless implants is perhaps due to failure of primary stability even following adequately treated IOPFF [9].…”