Three Differing Methods of Treating Intraoperative Nondisplaced Calcar Fractures Demonstrate Similar Radiographic...

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Intraoperative calcar fractures during total hip arthroplasty (THA) require effective management strategies.
• Current approaches include cerclage cables (CCs), modular tapered-fluted (MTF) stems, or fully-coated (FC) diaphyseal-engaging stems.

Purpose of the Study:

• To compare the radiographic and clinical outcomes of three distinct intraoperative calcar fracture management strategies in THA.
• To evaluate stem subsidence and complication rates for each treatment approach.

Main Methods:

• Retrospective review of 50 patients with intraoperative calcar fractures from 9,129 primary THAs.
• Patients were managed with CCs, MTF stems, or FC stems by three different surgeons.
• Stem subsidence was assessed radiographically at 3 months and 1 year; complication rates were evaluated.

Main Results:

• No significant difference in stem subsidence was observed at 3 months or 1 year across the CC, MTF, and FC groups.
• Overall reoperation rate was 12%, with infections in the FC group and fractures in MTF/FC groups.
• Instability requiring closed reduction occurred in the CC group.

Conclusions:

• All three management strategies for intraoperative calcar fractures resulted in low radiographic stem subsidence.
• The overall risk of reoperation associated with these THA fracture management techniques was higher than expected.