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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty
Simo S A Miettinen1, Tatu J Mäkinen2, Inari Kostensalo3
1a Department of Orthopaedics, Traumatology and Hand Surgery , Kuopio University Hospital , Kuopio .
Insights
Intraoperative calcar fractures during cementless total hip arthroplasty (THA) occurred in 3.7% of cases and increased revision risk. Lower age and the Hardinge approach were identified as key risk factors.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Intraoperative periprosthetic femoral fracture is a recognized complication of cementless total hip arthroplasty (THA).
- Calcar fractures specifically represent a subset of these intraoperative fractures.
- Understanding the incidence and risk factors for calcar fractures is crucial for improving surgical outcomes.
Purpose of the Study:
- To determine the incidence of intraoperative calcar fractures during cementless THA.
- To identify risk factors associated with intraoperative calcar fractures.
- To assess the impact of intraoperative calcar fractures on the risk of revision surgery.
Main Methods:
- Retrospective analysis of 3,207 cementless THAs.
- Inclusion of 118 patients with intraoperative calcar fractures and a matched control group.
- Evaluation of demographic, surgical, implant, and femoral morphology data.
Main Results:
- The incidence of intraoperative calcar fractures was 3.7% (118/3,207).
- Revision rates were significantly higher in the calcar fracture group (10%) compared to the control group (3.4%).
- Risk factors included the Hardinge surgical approach, younger patient age, deviated femoral anatomy, and thinner proximal femur cortices.
Conclusions:
- Intraoperative calcar fractures are associated with an increased risk of revision THA.
- Younger age and the Hardinge approach are significant risk factors for calcar fractures.
- Careful consideration of femoral morphology (deviated anatomy, thin cortices) is essential when using cementless stems to prevent intraoperative fractures.
Background And Purpose:
Intraoperative periprosthetic femoral fracture is a known complication of cementless total hip arthroplasty (THA). We determined the incidence of--and risk factors for--intraoperative calcar fracture, and assessed its influence on the risk of revision.
Patients And Methods:
This retrospective analysis included 3,207 cementless THAs (in 2,913 patients). 118 intraoperative calcar fractures were observed in these hips (3.7%). A control group of 118 patients/hips without calcar fractures was randomly selected. The mean follow-up was 4.2 (1.8-8.0) years. Demographic data, surgical data, type of implant, and proximal femur morphology were evaluated to determine risk factors for intraoperative calcar fracture.
Results:
The revision rates in the calcar fracture group and the control group were 10% (95% CI: 5.9-17) and 3.4% (CI: 1.3-8.4), respectively. The revision rate directly related to intraoperative calcar fracture was 7.6%. The Hardinge approach and lower age were risk factors for calcar fracture. In the fracture group, 55 of 118 patients (47%) had at least one risk factor, while only 23 of118 patients in the control group (20%) had a risk factor (p = 0.001). Radiological analysis showed that in the calcar fracture group, there were more deviated femoral anatomies and proximal femur bone cortices were thinner.
Interpretation:
Intraoperative calcar fracture increased the risk of revision. The Hardinge approach and lower age were risk factors for intraoperative calcar fracture. To avoid intraoperative fractures, special attention should be paid when cementless stems are used with deviant-shaped proximal femurs and with thin cortices.
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