Fraturas periprotéticas do fêmur no peroperatório das artroplastias totais primárias do quadril

 

 Permissions and Reprints

Resumo

Objetivo Determinar a incidência de fraturas periprotéticas do fêmur no peroperatório em artroplastias primárias do quadril e correlacioná-las com os fatores de risco inerentes aos pacientes, implantes e ao diagnóstico de coxoartrose e/ou fratura do colo do fêmur.

Métodos Estudo transversal, com análise retrospectiva de prontuários e exames de imagem de arquivos dos pacientes operados entre 2014 e 2019. As variáveis analisadas seguiram o proposto pela literatura mundial, sendo elas: idade, sexo, índice de Dorr, indicação cirúrgica, classificação de Vancouver, local, tipo de fixação (cimentada ou não cimentada), modelo do implante utilizado, diagnóstico intraoperatório e tratamento instituído. Todas as cirurgias utilizaram a mesma via de acesso póstero-lateral e foram realizadas pelo mesmo grupo de cirurgiões.

Resultados Dentro da amostra de 2.217 artroplastias (2.154 pacientes) foram identificadas 12 fraturas (0,56%) em 12 pacientes. A amostra foi composta por 8 pacientes do gênero feminino e 4 do gênero masculino, com média de idade de 62,53 anos. Em todos os casos diagnosticados foram adicionadas cerclagens de proteção ao nível do pequeno trocanter e ou do grande trocanter e em 3 casos houve mudança de hastes femorais não cimentadas para cimentadas e apenas 1 evoluiu com necessidade de revisão.

Conclusão A análise dos dados permite afirmar que o risco de fratura periprotética intraoperatória é maior em mulheres e com o uso de hastes não cimentadas. A ocorrência destas neste estudo teve taxa inferior a 1%.

Trabalho desenvolvido no Hospital Universitário Cajuru, Curitiba, PR, Brasil.

Publication History

Received: 24 October 2022

Accepted: 10 August 2023

Article published online:
31 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

• Referências

• 1 Galia CR, Diesel CV, Guimarães MR, Ribeiro TA. Atualização em artroplastia total de quadril: uma técnica ainda em desenvolvimento. Rev Bras Ortop 2017; 52 (05) 521-527
  CrossrefPubMedSearch in Google Scholar
• 2 Hoskins W, Bingham R, Lorimer M, Hatton A, de Steiger RN. Early rate of revision of total hip arthroplasty related to surgical approach: an analysis of 122,345 primary total hip arthroplasties. J Bone Joint Surg Am 2020; 102 (21) 1874-1882
  CrossrefPubMedSearch in Google Scholar
• 3 Mayle RE, Della Valle CJ. Intra-operative fractures during THA: see it before it sees us. J Bone Joint Surg Br 2012; 94 (11, Suppl A) 26-31
  CrossrefPubMedSearch in Google Scholar
• 4 Davidson D, Pike J, Garbuz D, Duncan CP, Masri BA. Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am 2008; 90 (09) 2000-2012
  CrossrefPubMedSearch in Google Scholar
• 5 Liu B, Ma W, Li H, Wu T, Huo J, Han Y. Incidence, classification, and risk factors for intraoperative periprosthetic femoral fractures in patients undergoing total hip arthroplasty with a single stem: a retrospective study. J Arthroplasty 2019; 34 (07) 1400-1411
  CrossrefPubMedSearch in Google Scholar
• 6 Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone 1993; 14 (03) 231-242
  CrossrefPubMedSearch in Google Scholar
• 7 Miettinen SS, Mäkinen TJ, Kostensalo I. et al. Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty. Acta Orthop 2016; 87 (02) 113-119
  CrossrefPubMedSearch in Google Scholar
• 8 Ponzio DY, Shahi A, Park AG, Purtill JJ. Intraoperative Proximal Femoral Fracture in Primary Cementless Total Hip Arthroplasty. J Arthroplasty 2015; 30 (08) 1418-1422
  CrossrefPubMedSearch in Google Scholar
• 9 Sheth NP, Brown NM, Moric M, Berger RA, Della Valle CJ. Operative treatment of early peri-prosthetic femur fractures following primary total hip arthroplasty. J Arthroplasty 2013; 28 (02) 286-291
  CrossrefPubMedSearch in Google Scholar
• 10 Haynes JA, Hopper Jr RH, Ho H, McDonald III JF, Parks NL, Hamilton WG. Direct Anterior Approach for Primary Total Hip Arthroplasty Lowers the Risk of Dislocation Compared to the Posterior Approach: A Single Institution Experience. J Arthroplasty 2022; 37 (03) 495-500
  CrossrefPubMedSearch in Google Scholar
• 11 Lamb JN, Matharu GS, Redmond A, Judge A, West RM, Pandit HG. Risk Factors for Intraoperative Periprosthetic Femoral Fractures During Primary Total Hip Arthroplasty. An Analysis From the National Joint Registry for England and Wales and the Isle of Man. J Arthroplasty 2019; 34 (12) 3065-3073.e1
  CrossrefPubMedSearch in Google Scholar
• 12 Nichols CI, Vose JG, Nunley RM. Clinical outcomes and 90-day costs following hemiarthroplasty or total hip arthroplasty for hip fracture. J Arthroplasty 2017; 32 (9S): S128-S134
  CrossrefPubMedSearch in Google Scholar
• 13 Trousdale WH, Abdel MP, Viste A, Trousdale RT, Callaghan JJ, Berry DJ. Seasonality of periprosthetic femur fractures in 12,700 primary and revision total hip arthroplasties. J Arthroplasty 2017; 32 (06) 2000-2004
  CrossrefPubMedSearch in Google Scholar
• 14 Abdel MP, Watts CD, Houdek MT, Lewallen DG, Berry DJ. Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. [published correction appears in Bone Joint J 2020;102-B(12):1782] Bone Joint J 2016; 98-B (04) 461-467
  CrossrefPubMedSearch in Google Scholar
• 15 Osterhoff G, Morgan EF, Shefelbine SJ, Karim L, McNamara LM, Augat P. Bone mechanical properties and changes with osteoporosis. Injury 2016; 47 (Suppl 2) S11-S20
  CrossrefPubMedSearch in Google Scholar
• 16 Olsen F, Kotyra M, Houltz E, Ricksten SE. Bone cement implantation syndrome in cemented hemiarthroplasty for femoral neck fracture: incidence, risk factors, and effect on outcome. Br J Anaesth 2014; 113 (05) 800-806
  CrossrefPubMedSearch in Google Scholar
• 17 Gundtoft PH, Varnum C, Pedersen AB, Overgaard S. The Danish Hip Arthroplasty Register. Clin Epidemiol 2016; 8: 509-514
  CrossrefPubMedSearch in Google Scholar
• 18 Chana R, Mansouri R, Jack C. et al. The suitability of an uncemented hydroxyapatite coated (HAC) hip hemiarthroplasty stem for intra-capsular femoral neck fractures in osteoporotic elderly patients: the Metaphyseal-Diaphyseal Index, a solution to preventing intra-operative periprosthetic fracture. J Orthop Surg Res 2011; 6: 59
  CrossrefPubMedSearch in Google Scholar
• 19 Wangen H, Havelin LI, Fenstad AM. et al. Reverse hybrid total hip arthroplasty. Acta Orthop 2017; 88 (03) 248-254
  CrossrefPubMedSearch in Google Scholar
• 20 Colacchio ND, Robbins CE, Aghazadeh MS, Talmo CT, Bono JV. Total Hip Intraoperative Femur Fracture: Do the Design Enhancements of a Second-Generation Tapered-Wedge Stem Reduce the Incidence?. J Arthroplasty 2017; 32 (10) 3163-3168
  CrossrefPubMedSearch in Google Scholar
• 21 Carli AV, Negus JJ, Haddad FS. Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture?. Bone Joint J 2017; 99-B (1, Supple A) 50-59
  CrossrefPubMedSearch in Google Scholar
• 22 Zhao R, Cai H, Liu Y, Tian H, Zhang K, Liu Z. Risk factors for intraoperative proximal femoral fracture during primary cementless THA. Orthopedics 2017; 40 (02) e281-e287
  CrossrefPubMedSearch in Google Scholar
• 23 Klein GR, Parvizi J, Vegari DN, Rothman RH, Purtill JJ. Total hip arthroplasty for acute femoral neck fractures using a cementless tapered femoral stem. J Arthroplasty 2006; 21 (08) 1134-1140
  CrossrefPubMedSearch in Google Scholar
• 24 Richardson CG, Lethbridge LN, Dunbar MJ. Increased mortality with the use of cementless fixation for femoral neck fractures: analysis of 5883 hip arthroplasty cases. J Arthroplasty 2020; 35 (12) 3627-3630
  CrossrefPubMedSearch in Google Scholar
• 25 Ekman E, Laaksonen I, Isotalo K, Liukas A, Vahlberg T, Mäkelä K. Cementing does not increase the immediate postoperative risk of death after total hip arthroplasty or hemiarthroplasty: a hospital-based study of 10,677 patients. Acta Orthop 2019; 90 (03) 270-274
  CrossrefPubMedSearch in Google Scholar
• 26 Berend KR, Lombardi Jr AV. Intraoperative femur fracture is associated with stem and instrument design in primary total hip arthroplasty. Clin Orthop Relat Res 2010; 468 (09) 2377-2381
  CrossrefPubMedSearch in Google Scholar
• 27 Bigart KC, Nahhas CR, Ruzich GP. et al. Does Femoral Morphology Predict the Risk of Periprosthetic Fracture After Cementless Total Hip Arthroplasty?. J Arthroplasty 2020; 35 (6S): S359-S363
  CrossrefPubMedSearch in Google Scholar