Abstract
Peri-operative fracture during routine THA represents one of the “not so fresh” feelings that occur for both patients and surgeons. With the increase in uncemented implants and MIS techniques this truly is a problem on the rise. We have recently examined and quantified the risk factors associated with proximal femoral fracture during THA. Risk factors (risk ratios) identified were: uncemented stems (8.9), anterolateral approach (7.4) and female gender (2.2). Fortunately, treatment with cerclage wiring for uncemented stems has facilitated excellent stem stability and acceptable survivorship with many different femoral component designs. Reduced proximal geometry stems that match the endosteal osseous anatomy have reduced fracture rates at our institution. In our series, cemented stems, however, had decreased survivorship in the presence of a proximal femoral fracture. MIS techniques may accelerate rehabilitation but they certainly permit limited visibility of the proximal femoral and acetabular anatomy and may result in less accurate component position. Relatively high fracture rates in series of MIS-THA have been reported. A bigger concern, however, is the unrecognised fracture that displaces postoperatively and requires a return to surgery for treatment with or without revision and mandates that we “see it before it sees us!” Cerclage wiring with looped Luque wires has been our treatment of choice for many years. Wires are significantly less expensive than cables and have proven to be durable in our series. They allow intraoperative repositioning and variable tightening in multiple locations. Cable fretting and breakage has been common in our experience with braided cable devices. Acetabular fracture during uncemented THA is most likely an under-reported occurrence and has been associated with elliptical component designs and under-reaming. In the presence of a stable cup, long-term performance has been acceptable.
