Outcome after proximal femoral fractures during primary total hip replacement by the direct anterior approach

被引:27
作者
Ruediger, Hannes A. [1 ,2 ]
Betz, Michael [1 ]
Zingg, Patrick O. [1 ]
McManus, John [2 ]
Dora, Claudio F. [1 ]
机构
[1] Univ Zurich, Dept Orthopaed, Zurich, Switzerland
[2] Univ Lausanne, Dept Orthopaed, CHUV, CH-1011 Lausanne, Switzerland
关键词
Total hip arthroplasty; Intraoperative fracture; Anterior approach; Outcome; DIRECT LATERAL APPROACH; ARTHROPLASTY; INSTRUMENT; MANAGEMENT; KNEE;
D O I
10.1007/s00402-013-1697-6
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
The literature suggests that intraoperative fractures of the greater trochanter and the metaphysis are increased with uncemented stems and the direct anterior approach. This study aims to determine the incidence and assess the functional and radiological outcome after such fractures. 484 consecutive total hip replacements (THR) (64 +/- A 12 years) were analyzed. We treated trochanteric fractures conservatively without any further denuding, and secured metaphyseal fissures with cerclages. Postoperative X-rays and at the latest follow-up were compared to assess secondary fracture displacement and stem subsidence. Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores after 1 year were analyzed. For each patient sustaining a fracture, two patients without fractures were matched in terms of age, body mass index and gender. 13 (2.7 %, 5 male, 68 +/- A 9 years) patients with intraoperative fractures of the greater trochanter (n = 8) or the metaphysis (n = 5) were analyzed. Consolidation was observed in 7/8 patients sustaining a trochanteric fracture while secondary displacement of the fragment occurred in one case. Stem subsidence was observed in 2/5 cases (5 and 7 mm). Patients who sustained a fracture showed a trend towards poorer WOMAC scores at 1 year postoperatively, compared to patients without fractures. A significantly increased joint stiffness was also observed. The intraoperative fracture risk in this series of THR through a direct anterior approach was 2.7 %. Trochanteric fractures do heal without primary fixation. Metaphyseal fractures heal well if immediately stabilized with a cerclage.
引用
收藏
页码:569 / 573
页数:5
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    Pedersen, Alma B.
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    [J]. ACTA ORTHOPAEDICA, 2008, 79 (03) : 327 - 334