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Does femoral stem choice influence fracture type or incidence for direct anterior approach total hip arthroplasty?

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Despite similar fracture rates, the incidence of intraoperative and post-operative fractures between standard (ST) length and short (SH) femoral stems remains unclear. Therefore, this study compared the incidence of intraoperative and early postoperative fractures between three ST and a single tapered-wedge SH femoral stem.

Materials and methods

Data were retrospectively collected on 1113 patients (1306 hips) having undergone total hip arthroplasty, via the anterior approach on a fracture table, between 2014 and 2019. One surgeon completed all ST procedures (314 hips), using one of three implants without discretion. One surgeon completed all SH procedures (992 hips), using one implant design. Differences between ST and SH groups were evaluated by independent t tests (continuous variables) and Chi-square tests (categorical variables).

Results

Patients in the SH group were significantly older (p < 0.001) and had a lower body mass index (p = 0.001) compared to the ST group. The total number of fractures was 12 (3.8%) and 14 (1.4%) in the ST and SH groups, respectively. The 12 ST fractures occurred intraoperatively, compared to two (0.2%) in the SH group. The remaining seven (0.7%) SH fractures occurred post-operatively. There was no difference in fracture rate between the three ST designs (p = 0.882). Interestingly, five (0.5%) insufficiency fractures were diagnosed in the SH group.

Conclusion

The risk of intraoperative and post-operative fractures following anterior total hip arthroplasty may be biased toward ST and SH implants, respectively. These results, along with the presence of five insufficient fractures, identify potential fracture risks and mechanisms for specific implant designs.

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Funding

This research received no specific grant from any funding agency in the public, commercial or non-for-profit sectors.

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Author notes

  1. Scott T. Nishioka

    Present address: John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA

Authors and Affiliations

  1. John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA

    Dylan B. Combs

  2. Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96818, USA

    Scott T. Nishioka, Samantha N. Andrews, Joseph Varcadipane & Cass K. Nakasone

  3. Department of Surgery, University of Hawai’i, John A. Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA

    Samantha N. Andrews & Cass K. Nakasone

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Correspondence to Samantha N. Andrews.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Hawai’i Pacific Health Research Institute (local Western Institutional Review Board) approved this study.

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This was a retrospective chart review and data collected were deidentified and presented as large scale, aggregate data. Therefore, no informed consent was obtained or required by the IRB.

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Combs, D.B., Nishioka, S.T., Andrews, S.N. et al. Does femoral stem choice influence fracture type or incidence for direct anterior approach total hip arthroplasty?. Arch Orthop Trauma Surg 142, 3515–3521 (2022). https://doi.org/10.1007/s00402-021-04236-w

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