Abstract
A concern with diaphyseal-fitting cementless stems in revision total hip arthroplasty is intra-operative fractures. Two hundred and eleven patients consecutively underwent revision hip arthroplasty using Solution stems (DePuy, Warsaw, IN). Intra-operative fractures or perforations occurred in sixty-four patients (30% prevalence), with diaphyseal splits in thirty-nine patients (18% prevalence). Risk factors were pre-operative osteolysis, cortex to canal ratio, under-reaming the cortex and large diameter stems. The majority of diaphyseal linear cracks occurred at the distal end of extended trochanteric osteotomies during stem insertion. Intra-operative fracture is associated with an average two days longer length of stay (p< 0.05).
The purpose of this study was to determine the identification of the risk factors and outcomes of intra-operative fractures using a diaphyseal fitting revision stem.
There is an association of intra-operative fracture associated using a diaphyseal-fitting stem in revision total hip arthroplasty with a longer length of stay in hospital.
Identifying preoperative risk factors will allow avoidance of such fractures and prolonged hospital stay.
Intra-operative fractures or perforations occurred in sixty-four patients (30% prevalence) and thirty-nine patients (18% prevalence) sustained diaphyseal splits. Risk factors associated with intra-operative fracture were pre-operative osteolysis, a low cortex to canal ratio, under-reaming the cortex and the use of a large diameter stem. Surgical approach was not directly related to fracture occurrence but the majority of diaphyseal undisplaced linear cracks occurred at the distal end of extended trochanteric osteotomies during stem insertion. Cortical perforation occurred most often with cement removal. Duration of stay was on average two days longer (p< 0.05) for patients with an intraoperative fracture.
Two hundred and eleven patients who had undergone revision hip arthroplasty using the Solution stem (DePuy, Warsaw, IN) between December 1998 and March 2002 were identified. Patients who sustained an intra-operative fracture were compared to controls patients who underwent hip revision at the same time frame but with no fracture. Multiple factors were analyzed to see which were risk factors for intra-operative fractures.
There is a surprisingly high incidence of intra-operative fracture associated with using a diaphyseal-fitting stem in revision total hip arthroplasty. This was associated with a longer length of stay
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
