Occult periprosthetic femoral fractures occur frequently during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA


Autoři: Ho Hyun Yun aff001;  Jung Taek Lim aff001;  Se-Hyun Yang aff001;  Phil Sun Park aff001
Působiště autorů: Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea aff001
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0221731

Souhrn

The present study aimed to investigate the prevalence and clinical consequences of occult intra-operative periprosthetic femoral fractures in total hip arthroplasty (THA). Between 2012 and 2017, a total of 113 primary THAs were enrolled. The mean age of the patients was 66.4 ± 7.6 years. We assessed occult intra-operative periprosthetic femoral fractures with the use of computed tomography (CT) and risk factors, including age, sex, body mass index, diagnosis, stem size, and radiographic parameters of proximal femoral geometry were analyzed. We also assessed the differences in thigh pain and stem subsidence and alignment between the patients with and without occult periprosthetic femoral fracture. Occult intra-operative periprosthetic femoral fractures were found in 13 of 113 hips (11.5%). In 9/13 (69.2%) of occult fractures, fracture lines were started from the region below the tip of the lesser trochanter. Six periprosthetic femoral fractures (5.3%) were found during the operation. Out of the five hips that had detected femoral fractures around the lesser trochanter intra-operatively, four hips (80%) showed concurrent occult fractures on different levels. The female sex (P = .01) and canal filling ratio at 7 cm below the tip of the lesser trochanter (P = .01) were significantly different between the patients with and without occult periprosthetic femoral fracture. The sex was significantly associated with an increased risk in predicting an occult intra-operative periprosthetic femoral fracture (odds ratio of male, 0.25 compared with the female; 95% CI, 0.08–0.85; p = .02). There was a significant difference in the incidence of thigh pain between occult fracture group and non-occult fracture group (P < .05). There were no significant differences in stem subsidence and alignment between the patients with and without occult periprosthetic femoral fracture. All 13 cases of occult intra-operative periprosthetic femoral fractures were healed at the final follow-up. Occult periprosthetic femoral fractures are common during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA, that CT scans are helpful to identify them, and that these fractures do not adversely affect the implant’s survival if a rigid fixation of the implants has been achieved.

Klíčová slova:

Research and analysis methods – Imaging techniques – Biology and life sciences – Neuroscience – Neuroimaging – Anatomy – Musculoskeletal system – Bioengineering – Biotechnology – Medical devices and equipment – Medical implants – Biomaterial implants – Medicine and health sciences – Diagnostic medicine – Diagnostic radiology – Tomography – Computed axial tomography – Radiology and imaging – Pelvis – Hip – Skeleton – Critical care and emergency medicine – Trauma medicine – Traumatic injury – Bone fracture – Surgical and invasive medical procedures – Musculoskeletal system procedures – Arthroplasty – Total hip arthroplasty – Engineering and technology


Zdroje

1. 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(9):2000–12. doi: 10.2106/JBJS.H.00331 18762663

2. Olory B, Havet E, Gabrion A, Vernois J, Mertl P. Comparative in vitro assessment of the primary stability of cementless press-fit acetabular cups. Acta Orthop Belg. 2004;70(1):31–7. 15055315

3. Abdel MP, Houdek MT, Watts CD, Lewallen DG, Berry DJ. Epidemiology of periprosthetic femoral fractures in 5417 revision total hip arthroplasties: a 40-year experience. Bone Joint J. 2016;98-b(4):468–74. doi: 10.1302/0301-620X.98B4.37203 27037428

4. Capello WN, D'Antonio JA, Naughton M. Periprosthetic fractures around a cementless hydroxyapatite-coated implant: a new fracture pattern is described. Clin Orthop Relat Res. 2014;472(2):604–10. doi: 10.1007/s11999-013-3137-x 23836241

5. Ricioli W Jr., Queiroz MC, Guimaraes RP, Honda EK, Polesello G, Fucs PM. Prevalence and risk factors for intra-operative periprosthetic fractures in one thousand eight hundred and seventy two patients undergoing total hip arthroplasty: a cross-sectional study. Int Orthop. 2015;39(10):1939–43. doi: 10.1007/s00264-015-2961-x 26298535

6. Berend KR, Lombardi AV Jr., Mallory TH, Chonko DJ, Dodds KL, Adams JB. Cerclage wires or cables for the management of intraoperative fracture associated with a cementless, tapered femoral prosthesis: results at 2 to 16 years. J Arthroplasty. 2004;19(7 Suppl 2):17–21.

7. Brown JM, Borchard KS, Robbins CE, Ward DM, Talmo CT, Bono JV. Management and Prevention of Intraoperative Acetabular Fracture in Primary Total Hip Arthroplasty. Am J Orthop (Belle Mead NJ). 2017;46(5):232–7.

8. Haidukewych GJ, Jacofsky DJ, Hanssen AD, Lewallen DG. Intraoperative fractures of the acetabulum during primary total hip arthroplasty. J Bone Joint Surg Am. 2006;88(9):1952–6. doi: 10.2106/JBJS.E.00890 16951110

9. Hasegawa K, Kabata T, Kajino Y, Inoue D, Tsuchiya H. Periprosthetic Occult Fractures of the Acetabulum Occur Frequently During Primary THA. Clin Orthop Relat Res. 2017;475(2):484–94. doi: 10.1007/s11999-016-5138-z 27800574

10. Dammerer D, Putzer D, Glodny B, Petersen J, Arrich F, Krismer M, et al. Occult intra-operative periprosthetic fractures of the acetabulum may affect implant survival. Int Orthop. 2018 Aug 10. [Epub ahead of print]

11. Gomez-Barrena E. CORR Insights((R)): Periprosthetic Occult Fractures of the Acetabulum Occur Frequently During Primary THA. Clin Orthop Relat Res. 2017;475(2):495–7. doi: 10.1007/s11999-016-5208-2 28004292

12. Wang F, Xue H, Yang X, Han W, Qi B, Fan Y, et al. Reduction of metal artifacts from alloy hip prostheses in computer tomography. J Comput Assist Tomogr. 2014;38(6):828–33. doi: 10.1097/RCT.0000000000000125 24983437

13. Reikeras O. Total Hip Arthroplasty With a Fully Hydroxyapatite-Coated Stem: A Cohort Study During 23–28 Years. J Arthroplasty. 2017;32(5):1543–6. doi: 10.1016/j.arth.2016.12.008 28043711

14. Vidalain JP. Twenty-year results of the cementless Corail stem. Int Orthop. 2011;35(2):189–94. doi: 10.1007/s00264-010-1117-2 20814676

15. Hallan G, Lie SA, Furnes O, Engesaeter LB, Vollset SE, Havelin LI. Medium- and long-term performance of 11,516 uncemented primary femoral stems from the Norwegian arthroplasty register. J Bone Joint Surg Br. 2007;89(12):1574–80. doi: 10.1302/0301-620X.89B12.18969 18057355

16. Froimson MI, Garino J, Machenaud A, Vidalain JP. Minimum 10-year results of a tapered, titanium, hydroxyapatite-coated hip stem: an independent review. J Arthroplasty. 2007;22(1):1–7. doi: 10.1016/j.arth.2006.03.003 17197301

17. Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol. 2007;188(6):1540–52. doi: 10.2214/AJR.06.0921 17515374

18. Schiessel A, Zweymuller K. The nutrient artery canal of the femur: a radiological study in patients with primary total hip replacement. Skeletal Radiol. 2004;33(3):142–9. doi: 10.1007/s00256-003-0728-8 14749902

19. Imre N, Battal B, Acikel CH, Akgun V, Comert A, Yazar F. The demonstration of the number, course, and the location of nutrient artery canals of the femur by multidetector computed tomography. Surg Radiol Anat. 2012;34(5):427–32. doi: 10.1007/s00276-011-0930-7 22241728

20. Barrack RL, Paprosky W, Butler RA, Palafox A, Szuszczewicz E, Myers L. Patients' perception of pain after total hip arthroplasty. J Arthroplasty. 2000;15(5):590–6. doi: 10.1054/arth.2000.6634 10959997

21. Al-Najjim M, Khattak U, Sim J, Chambers I. Differences in subsidence rate between alternative designs of a commonly used uncemented femoral stem. J Orthop. 2016;13(4):322–6. doi: 10.1016/j.jor.2016.06.026 27436922

22. Khalily C, Lester DK. Results of a tapered cementless femoral stem implanted in varus. J Arthroplasty. 2002;17(4):463–6. doi: 10.1054/arth.2002.32171 12066277

23. Noble PC, Alexander JW, Lindahl LJ, Yew DT, Granberry WM, Tullos HS. The anatomic basis of femoral component design. Clin Orthop Relat Res. 1988(235):148–65. 3416522

24. 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(3):231–42. doi: 10.1016/8756-3282(93)90146-2 8363862

25. Yeung Y, Chiu KY, Yau WP, Tang WM, Cheung WY, Ng TP. Assessment of the proximal femoral morphology using plain radiograph-can it predict the bone quality? J Arthroplasty. 2006;21(4):508–13. doi: 10.1016/j.arth.2005.04.037 16781402

26. Ishii S, Homma Y, Baba T, Ozaki Y, Matsumoto M, Kaneko K. 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? J Arthroplasty. 2016;31(7):1524–8. doi: 10.1016/j.arth.2016.01.016 26876944

27. Romagnoli S. Press-fit hip arthroplasty: a European alternative. J Arthroplasty. 2002;17(4 Suppl 1):108–12.

28. Malekmotiei L, Farahmand F, Shodja HM, Samadi-Dooki A. An analytical approach to study the intraoperative fractures of femoral shaft during total hip arthroplasty. J Biomech Eng. 2013;135(4):041004. doi: 10.1115/1.4023699 24231899

29. Cahir JG, Toms AP, Marshall TJ, Wimhurst J, Nolan J. CT and MRI of hip arthroplasty. Clin Radiol. 2007;62(12):1163–71. doi: 10.1016/j.crad.2007.04.018 17981163

30. Melvin JS, Karthikeyan T, Cope R, Fehring TK. Early failures in total hip arthroplasty—a changing paradigm. J Arthroplasty. 2014;29(6):1285–8. doi: 10.1016/j.arth.2013.12.024 24444568

31. Jo WL, Lee YK, Ha YC, Park MS, Lyu SH, Koo KH. Frequency, Developing Time, Intensity, Duration, and Functional Score of Thigh Pain After Cementless Total Hip Arthroplasty. J Arthroplasty. 2016;31(6):1279–82. doi: 10.1016/j.arth.2015.12.016 26775066

32. Ha YC, Koo KH, Jeong ST, Joon Yoo J, Kim YM, Joong Kim H. Cementless alumina-on-alumina total hip arthroplasty in patients younger than 50 years: a 5-year minimum follow-up study. J Arthroplasty. 2007;22(2):184–8. doi: 10.1016/j.arth.2006.02.169 17275631

33. Cooper HJ, Jacob AP, Rodriguez JA. Distal fixation of proximally coated tapered stems may predispose to a failure of osteointegration. J Arthroplasty. 2011;26(6 Suppl):78–83.

34. Sugano N, Noble PC, Kamaric E, Salama JK, Ochi T, Tullos HS. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg Br. 1998;80(4):711–9. 9699842

35. Umer M, Sepah YJ, Khan A, Wazir A, Ahmed M, Jawad MU. Morphology of the proximal femur in a Pakistani population. J Orthop Surg (Hong Kong). 2010;18(3):279–81.

36. Reddy AVG, Eachempati KK, Mugalur A, Suchinder A, Rao V, Kamurukuru N. 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. 2017;7(3):31–4. doi: 10.13107/jocr.2250-0685.792 29051875


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2019 Číslo 9

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