Femoral fractures in conjunction with total hip replacement

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Femoral fractures are a complication of total hip replacement (THR).
• These fractures can occur preoperatively, intraoperatively, or postoperatively.
• Management strategies vary based on fracture timing and patient factors.

Purpose of the Study:

• To review cases of femur fractures associated with THR.
• To analyze the effectiveness of different management strategies.
• To identify factors contributing to fracture occurrence and outcomes.

Main Methods:

• Retrospective review of 38 cases in 36 patients with femur fractures related to THR.
• Categorization of fractures into preoperative, intraoperative, and postoperative.
• Analysis of surgical techniques and outcomes.

Main Results:

• Preoperative fractures with hip disease treated effectively with custom THR components (long necks/stems).
• Intraoperative fractures often linked to reaming, component seating, or femur manipulation; require immediate custom components.
• Inadequate fixation led to non-union or loosening in 4/18 intraoperative cases.
• Postoperative fractures were rare; traction successful, surgical treatment hazardous.
• Long-stem components may prevent postoperative fractures through cortical defects.

Conclusions:

• Custom femoral components are crucial for managing preoperative and intraoperative femur fractures during THR.
• Careful surgical technique and appropriate component selection are vital to prevent intraoperative fractures.
• Further research is needed for optimal management of rare postoperative fractures.
• Prophylactic measures, including long-stem components, can mitigate postoperative fracture risk.