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European Journal of Orthopaedic Surgery & Traumatology

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01-10-2018 | Original Article • HIP - ARTHROPLASTY

High incidence of intraoperative calcar fractures with the cementless CLS Spotorno stem

Authors: Carla Timmer, Davey M. J. M. Gerhardt, Enrico de Visser, Marinus de Kleuver, Job L. C. van Susante

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 7/2018

Abstract

Introduction

This study reports on the incidence of intraoperative calcar fractures with the cementless Spotorno (CLS) stem, and the potential role of a learning curve and implant positioning is investigated.

Methods

After introduction of the CLS stem, 800 consecutive cementless total hip arthroplasties (THA) were analyzed. The incidence of calcar fracture in the first 400 THA was compared with the second 400 THA, in order to study a potential learning curve effect. According to the instruction for users, varus positioning of the stem was avoided and a femoral neck osteotomy was aimed relatively close to the lesser trochanter since these are assumed to be correlated with calcar fractures. Implant positioning (neck-shaft angle, femoral offset and osteotomy-lesser trochanter distance) was measured on postoperative pelvic radiographs of all THA with calcar fractures and 100 randomly selected uncomplicated control cases.

Results

Seventeen (2.1%) intraoperative calcar fractures were recorded. The incidence of calcar fracture differed between the first 400 THA (n = 11) and the second 400 THA (n = 6). This difference was not statistically significant (p = 0.220); however, these numbers indicate a trend toward a learning effect. No significant difference in stem positioning nor the height of the femoral neck osteotomy was measured between THA with a calcar fracture (n = 17) and the control cases (n = 100).

Conclusions

We report on a high incidence of intraoperative calcar fractures with the use of a CLS stem. The risk for calcar fractures remains clinically significant even after adequate implant positioning in the hands of experienced hip surgeons. Surgeons should be aware of this implant related phenomenon and be alert on this phenomenon intraoperatively.

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Title: High incidence of intraoperative calcar fractures with the cementless CLS Spotorno stem
Authors: Carla Timmer
Davey M. J. M. Gerhardt
Enrico de Visser
Marinus de Kleuver
Job L. C. van Susante
Publication date: 01-10-2018
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 7/2018
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-018-2217-8

At a glance: The STEP trials

Springer Medicine

High incidence of intraoperative calcar fractures with the cementless CLS Spotorno stem

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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