Risk Factors For Femoral Fracture Research Articles

Risk factors for femoral fracture in lateral decubitus direct anterior approach total hip arthroplasty using conventional stems: a retrospective analysis

ObjectiveTo provide guidelines for surgery and reduce the incidence of fracture, this study analyzed the relationship between femoral fracture and related factors in direct anterior approach (DAA) total hip arthroplasty (THA) in the lateral decubitus position.MethodA retrospective series of 273 consecutive patients who underwent THA with the DAA in the lateral decubitus position was analyzed. Each surgery was performed by the same surgeon with a conventional operation bed and femoral stem. The correlations between the incidence of fracture and sex, age, body mass index (BMI), height, osteoporosis, the anterior superior iliac spine-greater trochanter distance (ASIS-GTD), and hip joint disease were analyzed by univariate analysis and logistic regression analysis.ResultsAmong all hip arthroplasty procedures, 35 hips had femoral fractures, including 30 greater trochanter fractures, 4 proximal femoral splits, and 1 femoral perforation. The incidence of fracture was 12.82%. Univariate analysis showed no significant difference in the incidence of fracture by sex, BMI, or age. However, osteoporosis caused an increase in the incidence of fracture, while the incidence of fracture decreased as height and the ASIS-GTD increased. The incidence of femoral neck fracture was lower in cases of osteonecrosis of the femoral head than in cases of other diseases. Logistic regression showed a significant correlation between osteoporosis, the ASIS-GTD, and fractures. Patients with osteoporosis had a high possibility of fracture (OR = 2.414); the possibility of fracture decreased with increasing ASIS-GTD (OR = 0.938).ConclusionLateral decubitus DAA THA can be successfully performed using a conventional operation bed and stem, effectively saving medical resources. Osteoporosis and a shorter ASIS-GTD were independent risk factors for femoral fracture.

Femoral Fractures after Radical Treatment of Soft-Tissue Sarcomas of the Proximal Lower Extremity

The standard radical treatment for soft-tissue sarcomas of the proximal lower extremity comprises surgery, radiotherapy, or a combination of both, using radiotherapy as an adjuvant therapy. However, femoral bone fracture is a known critical late complication after radical treatment. Radiotherapy is a known risk factor for bone fractures, but the actual tolerance dose of the femur bone remains uncertain. In this study, we investigated the relationship between clinical, dosimetric factors and femoral fractures after radical treatment for soft-tissue sarcomas of the proximal lower extremity. Patients radically treated for soft-tissue sarcomas of the proximal lower extremity between October 2003 and August 2018 were retrospectively examined. The endpoint was femoral fracture rate. We censored fractures within the treated area without trauma as events. Additionally, univariate analysis was conducted for clinical predictive factors. Dosimetric analysis [prescription dose/irradiated length/mean dose/maximum dose/volume (Vd) receiving specified doses (30–60 Gy)of the femur bone] was also conducted for patients with full three-dimensional dose data. Dose data were analyzed using equivalent 2-Gy-dose (EQD2), and patients without radiotherapy were considered as 0 Gy. A total of 178 patients (median age: 65.5 years; 58% men; 42% women) were examined over a median follow-up of 46.5 (range, 0–174) months. 171 patients (96%) underwent surgery, 22 (12%) received periosteal stripping, and 44 (25%) received radiation therapy with a median prescription EQD2 dose of 50 (range, 8–70) Gy. Five patients developed femoral fractures at a median time to fracture of 28 (16–53) months after radical treatment. All five patients underwent surgery, periosteal stripping, and radiation therapy. Periosteal stripping (p = 000019) and radiation therapy (p = 0.00077) were significant risk factors of the fracture. In 168 patients with available full three-dimensional dose date, prescription dose/irradiated bone length/mean dose/maximum dose/V30–60 all showed significant difference between fracture and non-fracture patients. Furthermore, limited to the patients who underwent periosteal stripping (n = 19), dosimetric analysis revealed a maximum femur bone dose threshold of 53.8Gy made a significant difference in fracture risk (p=0.0048). The femoral fracture rate after radically treated soft-tissue sarcomas of the proximal lower extremity was 2.8%. Radiation therapy and periosteal stripping were significant risk factors for femoral fracture. In patients who undergo periosteal stripping, reduction of the femoral bone dose, especially maximum dose, may be effective for fracture prevention.

Incidence of and risk factors for femoral fractures in the gap between hip and knee implants.

The purpose of this study was to analyse the incidence of interprosthetic femoral fractures and describe risk factors for them. Between 2009 and 2015, we selected patients who were carrying two implants (hip and knee) in the same femur. We collected demographic and clinical data and performed a radiological evaluation to analyse the gap between implants-the femoral canal area and total femoral area-in the axial plane. We defined interprosthetic fracture as that corresponding to a Vancouver type C fracture and types 1 and 2 according to the Su classification. We studied 68 patients who had total knee arthroplasty (TKA), and 44 patients who had total hip arthroplasty (THA); 24 patients an intramedullary nail. We found six interprosthetic fractures (8.8%), all in patients with a non-cemented THA. There was a tendency towards statistical difference (p = 0.08). Patients with an additional implant at the proximal femur were statistically less likely to have an interprosthetic fracture (p = 0.04). In radiological results, we found more interprosthetic fractures in patients who had an increased femoral canal area in the axial plane just distal to the tip of the hip implant. Identifying risk factors for this specific type of fracture may facilitate their prevention. Better implant stability and the presence of a gap between stems in a lower canal zone appear to hinder the occurrence of interprosthetic fractures.

Risk Factors for Femoral Fracture after Canine Press-Fit Cementless Total Hip Arthroplasty

To evaluate risk factors for femoral fracture after porous-coated cementless total hip arthroplasty (THA). Case series. Dogs (n=74) that had cementless THA (n=84). Medical records of dogs from 2 referral hospitals were reviewed for occurrence of postoperative femoral fracture. Patient and operative (age, breed, sex, weight, and canal flare index [CFI], indication for arthroplasty, intraoperative fissure, cerclage usage, and implant sizes) factors were analyzed. Assessment of implant positioning and canal fill was performed on immediate postoperative radiographs. Femoral fractures (n=11) were evaluated and compared with 73 cases without fracture that met the inclusion criteria. Mean (+/-SEM) age was 7.30+/-0.69 years for dogs with, and 4.77+/-0.37 years for dogs without femoral fracture. Age was positively associated with fracture (P=.022). Mean (+/-SEM) CFI was 1.80+/-0.09 for dogs with, and 1.98+/-0.04 for dogs without fracture. CFI was negatively associated with fracture (P=.045). Body weight, intraoperative fissure, cerclage use, implant size, position, and canal fill did not influence the occurrence of femoral fracture. Older dogs and dogs with lower CFI may be at increased risk for femoral fracture after porous-coated cementless THA. Risk factors exist for femoral fracture after cementless THA using porous-coated implants, and should be critically evaluated during the patient selection. These risks should be weighed against the benefits of the system, and measures to minimize femoral fracture in at-risk patients studied.

The Effect of Femoral Notching During Total Knee Arthroplasty on the Prevalence of Postoperative Femoral Fractures and on Clinical Outcome

The treatment of a supracondylar femoral fracture following total knee arthroplasty is complicated by the presence of the prosthetic components. Anterior femoral notching during arthroplasty has been implicated as a contributing risk factor for femoral fracture. We retrospectively reviewed the effect of anterior femoral notching on the subsequent occurrence of a periprosthetic supracondylar fracture of the distal aspect of the femur and the outcomes of primary total knee arthroplasty in such patients. The prevalence and depth of femoral notching were determined on a review of the lateral radiographs by observers blinded to the clinical results of 1089 consecutive total knee replacements performed in 1997 and 1998. Linear and logistic regression modeling was used to analyze the relationship between femoral notching and the prevalence of supracondylar femoral fracture, postoperative range of motion, the Knee Society score, and the Knee Society functional and pain scores. Femoral notching was performed in 325 (29.8%) of the 1089 knees in our series. During an average follow-up period of 5.1 years, only two supracondylar femoral fractures occurred, both in femora treated without notching. Femoral notching was not associated with an increased rate of fracture (p = 1.000) or with significant differences in the measures of outcome (range of motion [p = 0.117], knee score [p = 0.967], functional score [p = 0.861], need for a lateral release [p = 0.234], or postoperative pain [p = 0.948]). This study demonstrated no difference in knees managed with or without notching of the anterior distal aspect of the femur with respect to the occurrence of a supracondylar fracture, range of motion, Knee Society score, Knee Society function, or pain.

Early complications after one hundred and forty-four consecutive hip revisions with impacted morselized allograft bone and cement.

The use of impacted morselized allograft bone and cement in hip revision arthroplasty has been popular, but studies that specifically address intraoperative and postoperative complications have been scarce. All complications that occurred during, and within the first year after, 144 consecutive hip revision arthroplasties (108 stems and 130 sockets) performed with impacted morselized allograft bone and cement were recorded. Clinical and radiographic follow-up evaluation was performed at three months and at one year after surgery for all patients except eight (seven who had died of causes unrelated to the hip surgery and one who had sustained a stroke). Of these eight patients, seven had a six-week and/or three-month follow-up evaluation. Thirty-nine femoral fractures occurred in thirty-seven hips; twenty-nine of the fractures occurred during surgery and ten, within five months after surgery. Of the intraoperative femoral fractures, twelve were proximal, nine were diaphyseal, and eight involved the greater trochanter. Of the postoperative femoral fractures, one was proximal and nine were diaphyseal. Other intraoperative complications were the creation of a femoral cortical window in seven hips and incidental perforation of the femoral cortex in fourteen. Multivariate analysis showed the risk factors for femoral fracture during or after revision to be concomitant disease, greater deficiency of the femoral bone stock, and an intraoperative femoral window or perforation. Other complications included dislocation of the femoral head in nine hips, deep infection in one hip, persistence of preoperative deep infection in one hip, and superficial wound infection requiring wound débridement in two hips. We found the complication rate to be high after hip revision arthroplasty performed with impacted morselized allograft bone and cement. The most serious complication was postoperative diaphyseal femoral fracture.