Preventing Periprosthetic Femur Fractures in Anterior-Based Approaches

Anterior approaches including the direct anterior and anterior-based muscle sparing approaches have grown in popularity for total hip arthroplasty. Despite many benefits, some studies have demonstrated an increased risk of periprosthetic fracture. Preoperatively, patient selection, careful templating, and strategic implant choice may decrease fracture risk. Recently, cemented stems and modern tapered, collared uncemented stems have been associated with lower fracture rates as well. Using careful surgical techniques, obtaining adequate exposure through sequential releases, and understanding various broaching strategies can all play a role in decreasing periprosthetic facture through anterior approaches to total hip arthroplasty.