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European Journal of Orthopaedic Surgery & Traumatology

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Open Access 26-09-2023 | Periprosthetic Femur Fracture | Original Article

Perioperative periprosthetic femur fracture associated with direct anterior total hip arthroplasty using metaphyseal fit and fill stem

Authors: Frederic Washburn, Jacob Mushaben, Clayton Eichenseer, Brent Sanderson, Britni Tran, Thomas Golden

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 2/2024

Abstract

Introduction

This study aims to identify radiographic and clinical risk factors of perioperative periprosthetic femur fracture associated with the direct anterior approach (DAA) using a metaphyseal fit and fill stem. We hypothesize stem malalignment with this femoral implant places increased stress on the medial calcar region, which leads to an increased risk of periprosthetic fracture.

Methods

We compared patients with periprosthetic femur fractures following DAA total hip arthroplasty (THA) utilizing the Echo Bi-Metric Microplasty Stem (Zimmer Biomet, Warsaw, IN) to a cohort of patients who did not sustain a periprosthetic fracture from five orthopedic surgeons over four years. Postoperative radiographs were evaluated for stem alignment, neck cut level, Dorr classification, and the presence of radiographic pannus. Univariate and logistic regression analyses were performed. Demographic and categorical variables were also analyzed.

Results

Fourteen hips sustained femur fractures, including nine Vancouver B2 and five AG fractures. Valgus stem malalignment, proud stems, extended offset, and patients with enlarged radiographic pannus reached statistical significance for increased fracture risk. Low femoral neck cut showed a trend toward statistical significance.

Conclusion

Patients undergoing DAA THA using a metaphyseal fit and fill stem may be at increased risk of perioperative periprosthetic fracture when the femoral stem sits proudly in valgus malalignment with extended offset and when an enlarged pannus is seen radiographically. This study identifies a specific pattern in the Vancouver B2 fracture cohort with regard to injury mechanism, time of injury, and fracture pattern, which may be attributed to coronal malalignment of the implant.

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Title: Perioperative periprosthetic femur fracture associated with direct anterior total hip arthroplasty using metaphyseal fit and fill stem
Authors: Frederic Washburn
Jacob Mushaben
Clayton Eichenseer
Brent Sanderson
Britni Tran
Thomas Golden
Publication date: 26-09-2023
Publisher: Springer Paris
Keywords: Periprosthetic Femur Fracture
Valgus Malposition
Hip-TEP
Hip-TEP
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 2/2024
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-023-03682-z

2024 ASCO Annual Meeting

Springer Medicine

Perioperative periprosthetic femur fracture associated with direct anterior total hip arthroplasty using metaphyseal fit and fill stem

Abstract

Introduction

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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