INFLUENCE ON THE CLINICAL OUTCOME OF AN INTRAOPERATIVE FRACTURE OF THE FEMUR IN CEMENTLESS TOTAL HIP REPLACEMENT – A ONE YEAR FOLLOW-UP

Abstract

Introduction: Intraoperative femoral fractures occurring in cementless total hip replacement are not frequent. In a series of in 350 consecutive hip replacements 15 cases of fractures were recognized and included for this study.

Materials and Methods: The fractures mainly occured during the femoral preparation rather than during the definitive stem impaction. Accurate reduction and stable internal fixation were considered necessary intraoperatively. Nevertheless in 4 cases the fixation of the stem was converted into a conventional cemented one. Postoperatively the patients were allowed to have an immediat full weight bearing on the operated side in 5 cases.

The remainders (10 patients) had a delayed reloading on the lower limb.

In this study the clinical and radiological results of the fracture group were compared to those of a control group of 15 patients.

Results: One year after surgery the Harris Hip score was no significantly different between the groups.

Postoperative complication rate (deep venous thrombosis, infection, dislocation) were not different between the groups.

There was a significant increase of duration of the stay of the patient in the rehabilitation center (p=0.007) in the fracture group and the patient spend more time with the physiotherapist (p=0.001)as they left the center.

The fracture rate was lower when the patients were operated by a senior surgeon (p=0.021).

Discussion: These results are comparable to those of the literature. Nevertheless intraoperative fractures of the proximal femur occurring in cementless total hip replacement do not jeopardize the clinical final outcome. This study emphasizes the importance of the learning–curve in cementless THR. Additional studies could assess the real costs for the medical care of such fractures.