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[Intra-operative fractures in hip arthroplasties: predisposing factors]
A G Graftiaux1, P Kehr, G Lang
1Hôpital Stéphanie (Hôpitaux Universitaires de Strasbourg), 26, route de la Lisière, F-67026, Strasbourg Cedex, France.
Insights
Intraoperative femoral fractures during total hip arthroplasty (THA) are linked to patient age, female sex, and bone fragility, particularly during stem impaction or in revision surgeries.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Geriatric Medicine
Context:
- Intraoperative femoral fractures are a known complication of total hip arthroplasty (THA).
- Understanding epidemiological factors and predisposing conditions is crucial for prevention.
- This study analyzes cases from multiple centers in eastern France.
Purpose:
- To analyze the epidemiology and predisposing factors of intraoperative femoral fractures during THA.
- To identify specific surgical steps and patient characteristics associated with fracture occurrence.
Summary:
- A multi-center study of 51 intraoperative femoral fractures in THA patients (average age 73, M/F ratio 0.5) found fractures often involved the diaphysis or cortical defects.
- Fractures occurred during reaming/impaction (50%) or dislocation (25%).
- Predisposing factors included bone mineral rarefaction (age, female sex) and reoperation cases with cortical bone fragility.
Impact:
- Findings highlight the importance of patient bone quality and surgical technique in preventing femoral fractures during THA.
- Identifies high-risk scenarios, aiding in surgical planning and risk mitigation strategies.
- Contributes to improving patient safety and outcomes in hip replacement surgery.
Abstract:
In a multi center study 51 cases of intraoperative femoral fractures in THA from 6 medical centers of eastern France were analysed with respect to epidemiology and predisposing factors. The male/female rate was 0,5 and the average age 73 years.The fractures involve the diaphysis in 33% and a cortical defect in 33%. The fracture occured in 50% of cases during reaming, or impaction of the femoral stem, and in 25% of cases during dislocation, these findings correspond to those described in the literature.The predisposing factors are of two types :- The rarefaction of the bone mineralisation due to the age and high proportion of females. 33% of the cases are a fracture of the femoral neck (elderly women).- Reoperation (27 cases) with 22 replacement of THA. In these cases of loosening, the fragility of the cortical bone (cement granuloma, chamber of mobility) is well known. On the other hand, we did not find that calcification or ankylosis are predisposing factors (only 8/51).
