Mini-anterolateral THA with cemented, collared stems reduced postoperative fracture risk
Use of cemented and collared stems during total hip arthroplasty through the mini-anterolateral approach reduced the risk of postoperative fracture requiring revision within the first 3 months, according to published results.
Researchers retrospectively reviewed 684 primary THAs performed with the mini-anterolateral approach for risk factors associated with perioperative periprosthetic femur fractures within 3 months of surgery. They evaluated gender, age, BMI, laterality and Dorr ratio of the proximal femur as risk factors and compared cemented and collared uncemented stems with uncemented tapered wedge and meta-diaphyseal stems.
Results showed 8.3% of the primary THAs performed resulted in fracture, of which 4.1% occurred intraoperatively and 4.2% occurred postoperatively within 90 days. Researchers fixed all intraoperative fractures at the time of surgery and the fractures healed uneventfully. However, 2.2% of the postoperative fractures were amenable to nonoperative management and healed, while 2% required revision arthroplasty, according to results.
Researchers noted 0% of patients with either cemented or collared stems experienced fracture compared with 9.8% of patients who received either tapered wedge or meta-diaphyseal fitting stems. Results showed female gender and increasing Dorr ratio increased the odds of fracture. Researchers found a trend toward increased risk of fracture with older age, but this did not achieve statistical significance, while BMI and laterality had no statistically significant effect.
“When performing primary THA via the [mini-anterolateral] AL approach, surgeons must use caution in these high-risk groups, and consider using a cemented or collared stem to decrease the change of [periprosthetic femur fracture] PFF,” the authors wrote.
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