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The patient should be advised she is at greater risk of stem subsidence and early revision
18%
980/5377
Female sex is a risk factor for intraoperative calcar fracture
60%
3243/5377
A better outcome would be expected if a long-stem diaphyseal fixation stem had been inserted after recognition of the calcar fracture
14%
726/5377
Cementless press-fit technique is not a risk factor for intraoperative fracture
1%
80/5377
Minimally invasive surgical approach is not a risk factor for intraoperative fracture
6%
317/5377
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Of the statements listed, the only true statement is that female gender is a risk factor for intraoperative calcar fracture. Calcar fractures are a documented complication of total hip arthroplasty. Studies have shown that successful outcomes can be achieved with stem removal, cable wiring of the calcar, and re-insertion of the primary stem. Berend et al. reviewed a series of 58 total hip arthroplasties who sustained an intraoperative calcar fracture. All were treated with cable wiring of the calcar and stem insertion. The authors report no femoral component subsidence or failure otherwise at 16 year follow-up. Graw et al. review a series of 46 revision THA's. Of the 46, fifteen underwent primary THA through a minimally invasive technique. The average length of time from primary THA to revision was 1.4 years for the minimally invasive group versus 14.7 years for the traditional exposure THA's. The authors conclude minimally invasive THA is a risk for early revision. Davidson et al. review intraoperative periprosthetic hip fractures. "Risk factors for intraoperative periprosthetic fractures include the use of minimally invasive techniques; the use of press-fit cementless stems; revision operations, especially when a long cementless stem is used or when a short stem with impaction allografting is used; female sex; metabolic bone disease; bone diseases leading to altered morphology such as Paget disease; and technical errors at the time of the operation." The authors summarize techniques for treatment and postulate that long term outcome is unaffected when the intraoperative fracture is identified and treated appropriately. Illustration A shows a nondisplaced calcar crack that was treated with a single Luque wire. Incorrect Answers: Answer 1. The patient is not at risk for further complications. See Berend reference. Answer 3. The patient is not at risk for further complications. See Berend reference. Answer 4. Intraoperative fractures occur more often with press-fit technique compared to cemented stems. Answer 5. Minimally invasive surgical approaches are a risk factor for intraoperative fracture during THA.
2.8
(26)
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