Risk factor analysis on perioperative greater trochanteric fracture of total hip arthroplasty via anterolateral approach.

Abstract

A greater trochanteric fracture is a perioperative complication of primary total hip arthroplasty (THA) via an anterolateral approach. Although surgeons determine risk factors in the preoperative planning phase, no study explored the relationship between the planned femoral implant and greater trochanter. This study attempts to determine the risk factors for perioperative greater trochanteric fractures in primary THA via an anterolateral approach. This retrospective single-institution study enrolled 440 patients (66 males and 374 females) who underwent primary THA via an anterolateral approach with a minimum follow-up of six months. First, we selected patients with perioperative greater trochanteric fractures, regardless of the need for additional surgery. Second, we investigated the risk factors for perioperative greater trochanteric fractures using the patients' demographic data, operative data, and femoral geometry data via univariate and multivariate analyses. Perioperative greater trochanteric fractures occurred in 30 joints (30/440, 6.8%), and all cases were reported in women. Multivariate analysis revealed that in cases where the top of the great trochanter was inside the longitudinal central axis of the planned femoral stem in three-dimensional templating (Type B) was the only independent risk factor for perioperative greater trochanteric fracture (odds ratio, 14.6; 95% confidence interval, 5.88-36.1; P < 0.001). This study identified female sex and Type B femoral geometry as risk factors for perioperative greater trochanteric fracture via an anterolateral approach. Our results may reduce the incidence of perioperative greater trochanteric fractures associated with primary THA.