Intraoperative Femur Fracture Risk During Primary Direct Anterior Approach Cementless Total Hip Arthroplasty With and Without a Fracture Table

• Published in: The Journal of arthroplasty Vol. 32; no. 9; pp. 2847 - 2851
• Main Authors: Cohen, Eric M., MD, Vaughn, Joshua J., MD, Ritterman, Scott A., MD, Eisenson, Daniel L., BS, Rubin, Lee E., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Adult; Aged; Aged, 80 and over; anterior approach; arthroplasty; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; Female; Femoral Fractures - diagnostic imaging; Femoral Fractures - etiology; Femoral Fractures - surgery; femur fracture; fracture table; Humans; Intraoperative Complications; intraoperative fracture; Joint Diseases - surgery; Male; Middle Aged; Operating Tables; Orthopedics; periprosthetic fracture; Retrospective Studies; Risk Factors; periprosthetic fracture; fracture table; anterior approach; arthroplasty; femur fracture; intraoperative fracture
• DOI: 10.1016/j.arth.2017.04.020
• ISSN: 0883-5403

Abstract Background There is no study to date comparing intraoperative femur fractures (IFFs) in the direct anterior approach (DAA) with and without a fracture table. We hypothesize that there is no significant difference in the IFF with and without a fracture table when performed by experienced DAA hip surgeons. Methods This study is a 1-year retrospective review of patients who underwent DAA total hip arthroplasty by 2 surgeons: one surgeon uses a flat table and manually elevates the femur with a large bone hook, while the other surgeon uses a fracture table and a mechanical femoral elevator. Exclusion criteria included cemented femoral implants, femoral neck fractures, and lack of 6-month follow-up. Results We identified 487 patients for analysis (220 male and 267 female, average age 66.55 years). There were 12 total IFFs (2.46%): 8 female and 4 male patients. The average age of IFF patients was 70.67 years and in nonfracture patients was 66.00 years. There was no difference in gender ( P  = .2981) or age ( P  = .2099) between IFF and nonfracture patients. In the fracture table group, there were 6 IFFs (2.22%) in 271 patients; in the nonfracture table group, there were 6 IFFs (2.76%) in 216 patients. There was no statistical difference in IFF between the 2 groups ( P  = .6973). We observed just 2 patients (0.4%) in this series where the IFFs changed management requiring a revision femoral stem. Conclusion There was no statistical difference in IFF with or without the use of fracture table. Both DAA surgical technique variations are felt to be equivalent regarding the risk for IFF during DAA cementless total hip arthroplasty.