Risk factors for intraoperative femoral fractures during total hip replacement

Background and Aims: Intraoperative femoral fractures are a serious complication of total hip replacement. The purpose of this study was to evaluate the risk factors of intraoperative femoral fractures in a retrospective analysis of a series of 3,566 total hip replacements. Materials and Methods: The patients were divided into two groups, A and B. Group A patients had no intraoperative femoral fractures and Group B patients had intraoperative femoral fractures. In Group A there were 3,483 patients (97.7 %) and in Group B, 83 (2.3 %). The following potential risk factors were evaluated: sex, age, diagnosis, previous surgery at the homolateral hip, surgical approach, fixation type of the femoral component, prosthesis type, surgical stage during which the fracture occurred, and the lead operating surgeon. Results: The fracture incidence was higher in females (p < 0.005) in uncemented femoral components (p = 0.005), in patients who had previous surgery at the homolateral hip (p < 0.005), and in revision surgery (p < 0.005). Conclusion: The analysis of intraoperative femoral fracture risk factors should allow the surgeon to improve the surgical performance and therefore reduce the incidence of this severe intraoperative complication.