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Updated: Nov 22, 2025
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Greater trochanter fractures in the direct anterior approach: evolution during learning curve, risk factors and
Constant Foissey1, Raymond Kenney2, Francesco Luceri3
1Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Center of Excellence, Croix-Rousse Hospital, 103 Grande rue de la Croix-Rousse, Rhône-Alpes, 69004, Lyon, France. constant.foissey@chu-lyon.fr.
Introduction:
Greater trochanter (GT) fractures affect 0.6-29% of patients after direct anterior approach (DAA) total hip arthroplasty (THA). Given the growing popularity of this approach, this study aimed to assess the evolution of the GT fractures during the learning curve, their risk factors and their consequences.
Materials And Methods:
537 total hip arthroplasties were retrospectively included from May 2013 to December 2017 in a single academic centre. Patient characteristics, perioperative management, clinical consequences and postoperative radiographs were analysed.
Results:
GT fractures represented 2.4% (n = 13) of the THA, and there was not a decrease with experience. The GT fracture patients did not require any additional support during the surgery, and full weight bearing was always allowed without any restriction. This complication only happened in females, with the risk significantly increased in those > 70 years old (OR = 4.9). There was no specific consequence during the follow-up, mean HHS score was 98.5 and all of the patients were satisfied or very satisfied postoperatively.
Conclusion:
Older osteoporotic women are known to be at risk for GT fracture during DAA THA. Those results reinforce the argument in favour of proper patient selection in DAA to lower the complications since it does not improve with surgeon's experience.
Level Of Evidence:
Retrospective, consecutive case series; Level IV.
