Risk factors and prevention of periprosthetic femoral fractures around the Corail stem during primary total hip arthroplasty

Abstract

Objective To investigate the causes and prevention of intraoperative periprosthetic femoral fractures around the Corail stem associated with primary total hip arthroplasty (THA). Methods A retrospective cohort study was made on 18 patients (18 hips) developing intraoperative periprosthetic femoral fractures around the Corail stem during primary THA between January 2010 and March 2016. There were 7 male and 11 female patients, with the age range of 42-81 years (mean, 57.6 years). At the time of diagnosis, six hips presented with inflammatory arthropathy, five avascular necrosis of the femoral head, four developmental dysplasia of hip, and three femoral neck fractures. Local problems were identified in 14 hips (77.8%), principally osteoporosis in 11 hips (61%). Fifteen periprosthetic femoral fractures were recognized intraoperatively and were treated with cerclage wires. Three intraoperatively occult fractures were observed on the postoperative radiograph, including one fracture treated non-operatively, one by wire cerclage fixation and one by open reduction internal fixation. Factors related to intraoperative fractures were analyzed. Harris score and Beals and Tower's criteria were used for clinical and radiological assessment respectively. Results Osteoporosis, inflammatory arthropathy, anatomical abnormity of the proximal femur, excessive pursuit of the degree of interference fit between prosthesis and cortical bone, and inappropriate choice of prosthesis size were the main causes of femur fractures during primary THA. Mean follow-up was 32 months. Union was obtained in all patients in a mean of 4.7 months. No prosthesis loosening and infection occurred. Mean Harris hip score was 91.2 points at the final follow-up. Radiological assessment showed excellent results in 16 hips and good results in two hips. Conclusions Rigidity in patient selection and master of surgery techniques are the key to preventing periprosthetic femoral fractures. Once the periprosthetic femoral fractures happens and the type is stable, cerclage wire fixation is a simple and satisfactory technique that is adequate for both implant and fracture stability. Key words: Arthroplasty, replacement, hip; Periprosthetic proximal femoral fracture; Risk factors