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Related Experiment Video

Updated: Feb 13, 2026

Fracture Apparatus Design and Protocol Optimization for Closed-stabilized Fractures in Rodents
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Isolated Greater Trochanteric Fracture and the Direct Anterior Approach Using a Fracture Table.

James M Hartford1, Bradley P Graw1, Sara B Knowles2

  • 1Center for Total Joint Replacement, Palo Alto Medical Foundation, Palo Alto, CA.

The Journal of Arthroplasty
|March 21, 2018
PubMed
Summary

Perioperative greater trochanter fractures occur in 2.2% of direct anterior approach total hip arthroplasties. Worse ambulatory status and specific radiographic ratios predict these fractures, which are successfully treated nonoperatively.

Keywords:
direct anterior approachfracture tablegreater trochanter fractureperiprosthetic fractureprimary hip arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Arthroplasty Research
  • Fracture Analysis

Background:

  • Direct anterior approach (DAA) total hip arthroplasty (THA) is increasingly common.
  • Perioperative fractures of the greater trochanter are a potential complication.
  • Understanding fracture incidence, predictors, and outcomes is crucial for surgical safety.

Purpose of the Study:

  • To determine the incidence of perioperative greater trochanter fractures during DAA THA.
  • To identify patient and radiographic factors contributing to these fractures.
  • To evaluate the outcomes of treated greater trochanter fractures.

Main Methods:

  • Retrospective analysis of 1401 primary THAs performed using the DAA.
  • Collection of patient demographics, comorbidities, and functional status.
  • Radiographic evaluation including femoral neck angle, femoral neck cut ratio (FNCR), and DORR ratio.
  • Bivariate and logistic regression analyses to identify fracture predictors.

Main Results:

  • An incidence of 2.2% (31 hips) for isolated greater trochanter fractures was observed.
  • Worse preoperative ambulatory status, slipped capital femoral epiphysis, rheumatoid arthritis, lower FNCR, and greater DORR ratio were significant predictors.
  • Intraoperative fractures (4) were fixed; postoperative fractures (27) were managed nonoperatively with one nonunion.

Conclusions:

  • Independent risk factors for greater trochanter fractures include poor preoperative mobility, specific diagnoses, and altered hip biomechanics (FNCR, DORR).
  • Fractures associated with DAA THA led to a longer hospital stay.
  • Nonoperative management demonstrated a high success rate for these fractures.