Periprosthetic Occult Femoral Fracture: An Unknown Side Effect of Press-Fit Fixation in Primary Cementless Total Hip Arthroplasty
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Purpose: The objectives of this study were to examine the prevalence and risk factors for development of periprosthetic occult femoral fractures during primary cementless total hip arthroplasty (THA) and to assess the clinical consequences of these fractures. Materials and Methods: A total of 199 hips were examined. Periprosthetic occult femoral fractures were defined as fractures not detected intraoperatively and on postoperative radiographs, but only observed on postoperative computed tomography (CT). Clinical, surgical, and radiographic analysis of variables was performed for identification of risk factors for periprosthetic occult femoral fractures. A comparison of stem subsidence, stem alignment, and thigh pain between the occult fracture group and the non-fracture group was also performed. Results: Periprosthetic occult femoral fractures were detected during the operation in 21 (10.6%) of 199 hips. Of eight hips with periprosthetic occult femoral fractures that were detected around the lesser trochanter, concurrent periprosthetic occult femoral fractures located at different levels were detected in six hips (75.0%). Only the female sex showed significant association with an increased risk of periprosthetic occult femoral fractures (odds ratio for males, 0.38; 95% confidence interval, 0.15-1.01; P=0.04). A significant difference in the incidence of thigh pain was observed between the occult fracture group and the non-fracture group (P<0.05). Conclusion: Occurrence of periprosthetic occult femoral fractures is relatively common during primary THA using tapered wedge stems. We recommend CT referral for female patients who report unexplained early postoperative thigh pain or developed periprosthetic intraoperative femoral fractures around the lesser trochanter during primary THA using tapered wedge stems.
Abstract
Purpose: The objectives of this study were to examine the prevalence and risk factors for development of periprosthetic occult femoral fractures during primary cementless total hip arthroplasty (THA) and to assess the clinical consequences of these fractures. Materials and Methods: A total of 199 hips were examined. Periprosthetic occult femoral fractures were defined as fractures not detected intraoperatively and on postoperative radiographs, but only observed on postoperative computed tomography (CT). Clinical, surgical, and radiographic analysis of variables was performed for identification of risk factors for periprosthetic occult femoral fractures. A comparison of stem subsidence, stem alignment, and thigh pain between the occult fracture group and the non-fracture group was also performed. Results: Periprosthetic occult femoral fractures were detected during the operation in 21 (10.6%) of 199 hips. Of eight hips with periprosthetic occult femoral fractures that were detected around the lesser trochanter, concurrent periprosthetic occult femoral fractures located at different levels were detected in six hips (75.0%). Only the female sex showed significant association with an increased risk of periprosthetic occult femoral fractures (odds ratio for males, 0.38; 95% confidence interval, 0.15-1.01; P=0.04). A significant difference in the incidence of thigh pain was observed between the occult fracture group and the non-fracture group (P<0.05). Conclusion: Occurrence of periprosthetic occult femoral fractures is relatively common during primary THA using tapered wedge stems. We recommend CT referral for female patients who report unexplained early postoperative thigh pain or developed periprosthetic intraoperative femoral fractures around the lesser trochanter during primary THA using tapered wedge stems.
참고문헌 (29)
- Michael Blankstein, "The Use of Cement in Hip Arthroplasty: A Contemporary Perspective", Journal of the American Academy of Orthopaedic Surgeons, 28(14), pp.e586~e594 (2020), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Anders Troelsen, "A Review of Current Fixation Use and Registry Outcomes in Total Hip Arthroplasty: The Uncemented Paradox", Clinical Orthopaedics & Related Research, 471(7), pp.2052~2059 (2013), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Kristine Ifigenia Bunyoz, "Has the Use of Fixation Techniques in THA Changed in This Decade? The Uncemented Paradox Revisited", Clinical Orthopaedics & Related Research, 478(4), pp.697~704 (2019), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Bo Liu, "Incidence, Classification, and Risk Factors for Intraoperative Periprosthetic Femoral Fractures in Patients Undergoing Total Hip Arthroplasty With a Single Stem: A Retrospective Study", The Journal of Arthroplasty, 34(7), pp.1400~1411 (2019), Elsevier BV[DOI]
- Kazuhiro Hasegawa, "Periprosthetic Occult Fractures of the Acetabulum Occur Frequently During Primary THA", Clinical Orthopaedics & Related Research, 475(2), pp.484~494 (2017), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Dietmar Dammerer, "Occult intra-operative periprosthetic fractures of the acetabulum may affect implant survival", International Orthopaedics, 43(7), pp.1583~1590 (2018), Springer Science and Business Media LLC[DOI]
- Enrique Gomez-Barrena, "CORR Insights®: Periprosthetic Occult Fractures of the Acetabulum Occur Frequently During Primary THA", Clinical Orthopaedics & Related Research, 475(2), pp.495~497 (2017), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Ho Hyun Yun, "Occult periprosthetic femoral fractures occur frequently during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA", PLOS ONE, 14(9), pp.e0221731~ (2019), Public Library of Science (PLoS)[DOI]
- Seiya Ishii, "Does the Canal Fill Ratio and Femoral Morphology of Asian Females Influence Early Radiographic Outcomes of Total Hip Arthroplasty With an Uncemented Proximally Coated, Tapered-Wedge Stem?", The Journal of Arthroplasty, 31(7), pp.1524~1528 (2016), Elsevier BV[DOI]
- H. John Cooper, "Distal Fixation of Proximally Coated Tapered Stems May Predispose to a Failure of Osteointegration", The Journal of Arthroplasty, 26(6), pp.78~83 (2011), Elsevier BV[DOI]
- Ho Hyun Yun, "A Validation Study for Estimation of Femoral Anteversion Using the Posterior Lesser Trochanter Line", The Journal of Arthroplasty, 28(10), pp.1776~1780 (2013), Elsevier BV[DOI]
- Tannast M, "Femoroacetabular impingement : radiographic diagnosis--what the radiologist should know", AJR Am J Roentgenol, 188, pp.1540~1552 (2007)[DOI]
- Munnan Al-Najjim, "Differences in subsidence rate between alternative designs of a commonly used uncemented femoral stem", Journal of Orthopaedics, 13(4), pp.322~326 (2016), Elsevier BV[DOI]
- Cyna Khalily, "Results of a tapered cementless femoral stem implanted in varus", The Journal of Arthroplasty, 17(4), pp.463~466 (2002), Elsevier BV[DOI]
- Lawrence D. Dorr, "Structural and cellular assessment of bone quality of proximal femur", Bone, 14(3), pp.231~242 (1993), Elsevier BV[DOI]
- William Nash, "The Dorr Type and Cortical Thickness Index of the Proximal Femur for Predicting Peri-Operative Complications during Hemiarthroplasty", Journal of Orthopaedic Surgery, 22(1), pp.92~95 (2014), SAGE Publications[DOI]
- Andreas Schiessel, "The nutrient artery canal of the femur: a radiological study in patients with primary total hip replacement", Skeletal Radiology, 33(3), pp.142~149 (2004), Springer Science and Business Media LLC[DOI]
- Nurcan Imre, "The demonstration of the number, course, and the location of nutrient artery canals of the femur by multidetector computed tomography", Surgical and Radiologic Anatomy, 34(5), pp.427~432 (2012), Springer Science and Business Media LLC[DOI]
- William N. Capello, "Periprosthetic Fractures Around a Cementless Hydroxyapatite-coated Implant: A New Fracture Pattern Is Described", Clinical Orthopaedics and Related Research®, 472(2), pp.604~610 (2013), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Barrack RL, "Patients’ perception of pain after total hip arthroplasty", J Arthroplasty, 15, pp.590~596 (2000)[DOI]
- Della Valle CJ, "Periprosthetic fractures of the acetabulum associated with a total hip arthroplasty", Instr Course Lect, 52, pp.281~290 (2003)
- Schwartz JT, Jr, "Femoral fracture during non-cemented total hip arthroplasty", J Bone Joint Surg Am, 71, pp.1135~1142 (1989)
- Reddy AVG, "Undisplaced intraoperative fracture presenting as early dislocation with tapered wedge stems in total hip arthroplasty-case series and review of literature", J Orthop Case Rep, 7, pp.31~34 (2017)
- Y. Yeung, "Assessment of the Proximal Femoral Morphology Using Plain Radiograph—Can it Predict the Bone Quality?", The Journal of Arthroplasty, 21(4), pp.508~513 (2006), Elsevier BV[DOI]
- J.G. Cahir, "CT and MRI of hip arthroplasty", Clinical Radiology, 62(12), pp.1163~1171 (2007), Elsevier BV[DOI]
- J. Stuart Melvin, "Early Failures in Total Hip Arthroplasty — A Changing Paradigm", The Journal of Arthroplasty, 29(6), pp.1285~1288 (2014), Elsevier BV[DOI]
- Woo-Lam Jo, "Frequency, Developing Time, Intensity, Duration, and Functional Score of Thigh Pain After Cementless Total Hip Arthroplasty", The Journal of Arthroplasty, 31(6), pp.1279~1282 (2016), Elsevier BV[DOI]
- Yong-Chan Ha, "Cementless Alumina-on-Alumina Total Hip Arthroplasty in Patients Younger Than 50 Years: A 5-year Minimum Follow-Up Study", The Journal of Arthroplasty, 22(2), pp.184~188 (2007), Elsevier BV[DOI]
- Leila Malekmotiei, "An Analytical Approach to Study the Intraoperative Fractures of Femoral Shaft During Total Hip Arthroplasty", Journal of Biomechanical Engineering, 135(4) (2013), ASME International[DOI]