Back
 OJO  Vol.4 No.3 , March 2014
Intraoperative Fracture of the Femur in Revision Total Hip Arthroplasty with a Fully HA-Coated Stem
Abstract: A retrospective review was made of intraoperative femoral fracture prevalence in seventy nine consecutive, cementless, fully HA-coated stems used for revision hip arthroplasty. Three patients were lost to follow up. Intraoperative fracture occurred in 15 (20%) femurs. Fractures occurred during cement removal (3/15) or insertion of the implant (12/15). All fractures were identified using intraoperative biplane X-ray, and were treated during the same operation. The clinical outcome of both groups (with or without fractures) was similar. The risk of intraoperative fracture was not statistically related to any demographic features or operative technique. Intraoperative radiographs are therefore mandatory in revision hip arthroplasty in order to diagnose and treat the common complication of femur fracture appropriately.
Cite this paper: Rothem, D. , Rothem, L. , Lerner, A. , Salamon, T. , Hiscock, R. and Bergman, N. (2014) Intraoperative Fracture of the Femur in Revision Total Hip Arthroplasty with a Fully HA-Coated Stem. Open Journal of Orthopedics, 4, 70-76. doi: 10.4236/ojo.2014.43012.
References

[1]   Dupont, J.A. and Charnley, J. (1972) Low-Friction Arthroplasty of the Hip for the Failures of Previous Operations. Journal of Bone Joint Surgery Br., 54, 77-87.

[2]   Federici, A., Carbone, M. and Sanguineti, F. (1988) Intraoperative Fractures of the Femoral Diaphysis in Hip Arthroprosthesis Surgery. Journal of Orthopaedics and Traumatology, 14, 311-321.

[3]   Haddad, F.S., Masri, B.A., Garbuz, D.S. and Duncan, C.P. (1999) The Prevention of Periprosthetic Fractures in Total Hip and Knee Arthroplasty. Orthopedic Clinics of North America, 30, 191-207.
http://dx.doi.org/10.1016/S0030-5898(05)70074-2

[4]   Terzi, S., Toni, A., Zanotli Russo, M.C., Nardi, D., Sudanese, A. and Giunti, A. (1997) Intraoperative Fracture of the Femur in Prosthetic Hip Reimplantations. La Chirurgia degli Organi di Movimento, 82, 221-230.

[5]   Wu, C.C., Au, M.K., Wu, S.S. and Lin, L.C. (1999) Risk Factors for Postoperative Femoral Fracture Incementless Hip Arthroplasty. Journal of the Formosan Medical Association, 98, 190-194.

[6]   Toni, A., Ciaroni, D., Sudanese, A., Femino, F., Marraro, M.D., Bueno Lozano, A.L. and Giunti, A. (1994) Incidence of Intraoperative Femoral Fracture. Straight-Stemmed versus Anatomiccementless Total Hip Arthroplasty. Acta Orthopaedica Belgica, 60, 43-54.

[7]   Egan, K.J. and Dicesare, P.E. (1995) Intraoperative Complications of Revision Hip Arthroplasty Using a Fully Porous-Coated Straight Cobalt-Chrome Femoral Stem. Journal of Arthroplasty, 10, S45-S51.
http://dx.doi.org/10.1016/S0883-5403(05)80230-X

[8]   Fitzgerald Jr., R.H., Brindley, G.W. and Kavanagh, B.F. (1988) The Uncemented Total Hip Arthroplasty. Intraoperative Femoral Fractures. Clinical Orthopaedics, 235, 61-66.

[9]   Gustilo, R.B. and Pasternak, H.S. (1988) Revision Total Hip Arthroplasty with Titanium Ingrowth Prosthesis and Bone Grafting for Failed Cemented Femoral Component Loosening. Clinical Orthopaedics and Related Research, 235, 111-119.

[10]   Lawrence, J.M., Engh, C.A., Macalino, G.E. and Lauro, G.R. (1994) Outcome of Revision Hip Arthroplasty Done without Cement. The Journal of Bone & Joint Surgery, 76A, 965-973.

[11]   Moreland, J.R. and Bernstein, M.L. (1995) Femoral Revision Hip Arthroplasty with Uncemented, Porous-Coated Stems. Clinical Orthopaedics and Related Research, 319, 141-150.

[12]   Malkani, A.L., Lewallen, D.G., Cabanela, M.E. and Wallrichs, S.L. (1996) Femoral Component Revision Using an Uncemented, Proximally Coated, Long-Stem Prosthesis. Journal of Arthroplasty, 11, 411-418.
http://dx.doi.org/10.1016/S0883-5403(96)80031-3

[13]   Engh, C.A., Culpepper, W.J. and Kassapidis, E. (1998) Revision of Loose Cementless Femoral Prostheses to Larger Porous Coated Components. Clinical Orthopaedics and Related Research, 347, 168-178.
http://dx.doi.org/10.1097/00003086-199802000-00019

[14]   Aribindi, R., Barba, M., Solomon, M.I., Arp, P. and Paprosky, W. (1998) Bypass Fixation. Orthopedic Clinics of North America, 29, 319-329.
http://dx.doi.org/10.1016/S0030-5898(05)70330-8

[15]   Krishnamurthy, A.B., MacDonald, S.J. and Paprosky, W.G. (1997) 5- to 13-Year Follow-Up Study on Cementless Femoral Components in Revision Surgery. Journal of Arthroplasty, 12, 839-847.
http://dx.doi.org/10.1016/S0883-5403(97)90152-2

[16]   Younger, T.I., Bradford, M.S., Magnus, R.E. and Paprosky, W.G. (1995) Extended Proximal Femoral Osteotomy. A New Technique for Femoral Revision Arthroplasty. Journal of Arthroplasty, 10, 329-338.
http://dx.doi.org/10.1016/S0883-5403(05)80182-2

[17]   Engh, C.A., Glassman, A.H., Griffin, W.L. and Mayer, J.G. (1988) Results of Cementless Revision for Failed Cemented Total Hip Arthroplasty. Clinical Orthopaedics, 235, 91-110.

[18]   Praprosky, W.G., Greidanus, N.V. and Antoniou, J. (1999) Minimum 10 Year Results of Extensively Porous-Coated Stems in Revision Hip Arthroplasty. Clinical Orthopaedics, 369, 230.
http://dx.doi.org/10.1097/00003086-199912000-00024

[19]   Zalzal, R., Gandi, R., Petruccelli, D., Petruccelli, D., Winemaker, M.J. and de Beer, J. (2003) Fractures at the Tip of Long-Stem Prostheses Used for Revision Hip Arthro-plasty. Journal of Arthroplasty, 18, 741-745.
http://dx.doi.org/10.1016/S0883-5403(03)00258-4

[20]   Meek, R.M., Garbuz, D.S., Masri, B.A., Greidanus, N.V. and Duncan, C.P. (2004) Intraoperative Fracture of the Femur in Revision Total Hip Arthroplasty with a Diaphyseal Fitting Stem. The Journal of Bone & Joint Surgery, 86, 480-485.

[21]   Chappell, J.D. and Lachiewicz, M.D. (2005) Fracture of the Femur in Revision Hip Arthroplasty with a Fully Porous-Coated Component. Journal of Arthroplasty, 20, 234-238.
http://dx.doi.org/10.1016/j.arth.2004.10.013

 
 
Top