Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty

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Miettinen , S S A , Mäkinen , T , Kostensalo , I , Mäkelä , K , Huhtala , H , Kettunen , J S & Remes , V 2016 , ' Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty ' , Acta Orthopaedica , vol. 87 , no. 2 , pp. 113-119 . https://doi.org/10.3109/17453674.2015.1112712

Title: Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty
Author: Miettinen, Simo S. A.; Mäkinen, Tatu; Kostensalo, Inari; Mäkelä, Keijo; Huhtala, Heini; Kettunen, Jukka S.; Remes, Ville
Contributor: University of Helsinki, I kirurgian klinikka (Töölö)
University of Helsinki, I kirurgian klinikka (Töölö)
Date: 2016-03-03
Language: eng
Number of pages: 7
Belongs to series: Acta Orthopaedica
ISSN: 1745-3674
URI: http://hdl.handle.net/10138/161255
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.
Subject: PROXIMAL FEMUR
FEMORAL COMPONENT
BONE QUALITY
MORPHOLOGY
TITANIUM
DESIGN
EPIDEMIOLOGY
SURVIVORSHIP
PROSTHESIS
MANAGEMENT
3126 Surgery, anesthesiology, intensive care, radiology
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