Risk Factors for Intraoperative Periprosthetic Femoral Fractures in Patients with Hip Dysplasia Undergoing Total Hip Arthroplasty with Uncemented Prostheses

Orthopaedic Surgery

Xiao Chen¹  Ze‐ming Liu¹  Hui‐jie Li¹  Si‐kai Liu¹  Tao Wu¹  Yong‐tai Han¹  Meng‐nan Li¹  Bo Liu¹ 

[1] Department of Osteonecrosis and Hip Surgery The Third Hospital of Hebei Medical University Shijiazhuang China;

关键词: Developmental dysplasia of the hip;    Intraoperative fractures;    Periprosthetic femoral fractures;    Risk factor;    Total hip arthroplasty;   

DOI  :  10.1111/os.13133

来源: DOAJ

【 摘 要 】

Objectives To determine the potential risk factors for intraoperative periprosthetic femoral fractures in patients with developmental dysplasia of the hip (DDH) undergoing total hip arthroplasty (THA). Methods This was a retrospective study. Patients who were diagnosed with DDH and undergoing THA (by artificial joint replacement) at our hospital from January 1999 to December 2019 were included in this study. Clinical and radiological factors were obtained from their medical records, such as age, sex, Crowe classification, morphological features of proximal femur, and features of surgical procedure. The outcome of interest was the occurrence of intraoperative periprosthetic femoral fracture, which was recorded and classified according to the Vancouver classification system. According to the fracture status, the patients were divided into two groups: the fracture group and the non‐fracture group. Multivariate logistic regression model was built to identify the risk factors for these fractures. Results A total of 1252 hips were finally included. Intraoperative periprosthetic femoral fractures were identified in 62 hips. The incidence of intraoperative periprosthetic femoral fractures in patients with DDH undergoing THA was 4.95%. There were 22 patients (proportion = 35.48%, incidence = 1.76%) with Type A fractures, 38 (proportion = 61.29%, incidence = 3.04%) with Type B fractures, and two (proportion = 3.23%, incidence = 0.16%) with Type C fractures. Six independent risk factors for intraoperative periprosthetic femoral fractures were identified: osteoporosis (OR = 3.434; 95% CI, 1.963–6.007), previous surgical history (OR = 4.797; 95% CI, 2.446–9.410), Dorr Type A canal (OR = 3.025; 95% CI, 1.594–5.738), retained femoral neck length (OR = 1.121; 95% CI, 1.043–1.204), implanted metaphyseal‐diaphyseal fixation stems (OR = 3.208; 95% CI, 1.562–6.591), and implanted stem with anteversion design (OR = 2.916; 95% CI, 1.473–5.770). Conclusions The overall incidence of intraoperative periprosthetic femoral fractures in patients with DDH undergoing THA was 4.95%, which was at a moderate level compared to patients with other diseases undergoing THA. Six independent risk factors were identified: osteoporosis, previous surgical history, Dorr Type A canal, insufficient neck osteotomy level, implantation of metaphyseal‐diaphyseal fixation stem, and implantation of a stem with an anteversion design. Comprehending these risk factors might help surgeons prevent the occurrence of these intraoperative periprosthetic femoral fractures in patients with DDH.

【 授权许可】

Unknown