Risk Factors for Intraoperative Proximal Femoral Fracture During Primary Cementless THA

Intraoperative proximal femoral fracture, one of the most common complications of total hip arthroplasty (THA), occurs more often in cementless procedures and can affect rehabilitation, hospitalization time, and cost of treatment. The goal of this study was to identify risk factors for intraoperative proximal femoral fracture in THA to identify high-risk groups preoperatively and minimize the incidence of this complication. This nested case-control study included 904 primary cementless THA procedures (769 patients) performed between January 2009 and July 2015. Of this group, 24 fractures occurred, accounting for 2.65% of cases. Predisposing factors for intraoperative proximal femoral fracture from the medical records included patient sex, diagnosis of osteoarthritis, operated on hip (left or right), type of implant, alcohol consumption, operative approach, age, and body mass index. The Noble classification, Dorr classification, and Metaphyseal-Diaphyseal Index score measured by picture archiving and communication systems were used to evaluate the anatomy and morphologic features of the proximal femur. A multivariate analysis was performed to evaluate potential risk factors for fracture during THA, including anterolateral (modified Hardinge) approach, use of the Corail (DePuy, Warsaw, Indiana) stem, Metaphyseal-Diaphyseal Index score, age, and sex. A Corail stem, the anterolateral approach, advanced age, and a low Metaphyseal-Diaphyseal Index score were associated with increased risk of fracture. All fractures were treated with cerclage wire techniques, and none has required revision to date. [Orthopedics. 2017; 40(2):e281-e287.].