Preventing and managing intraoperative fractures and perforations in hip arthroplasty

Intraoperative perforation of the femur, a serious complication of hip arthroplasty, encompasses a broad spectrum--from a simple hole in the bone to a displaced fracture with an unstable prosthesis. Although some intraoperative perforations are managed routinely, others are disastrous and often associated with greater morbidity, mortality, increased blood loss, and poor clinical outcome. Appropriate recognition, including an awareness of preoperative risk factors, is paramount to the successful management of these complications. We have found the S-ROM (DePuy Orthopaedics Inc., Warsaw, Ind) prosthesis safe in the prevention of cortical perforation in high-risk patients and effective in managing intraoperative perforation and fracture when it occurs.