Intraoperative Periprosthetic Fractures Associated With Uncemented Stems In Primary Total Hip Arthroplasty : Incidence, Management And Outcomes

Objective:The purpose of this observational study is to analysis the intraoperative periprosthetic fractures during primary total hip arthroplasty(THA). To explore the influence factors of the fractures. And in order to report the incidence, management, and outcomes of intraoperative periprosthetic fractures associated with the insertion of uncemented stems around primary total hip arthroplasty.Methods:Retrospectively analyze 559 cases(623 components) the same surgeon between January 2006 and April 2012 We identified 43 patients who sustained intraoperative periprosthetic fractures in 559 patients(623 stemmed implants) by Immediate radiographs postoperative. All of the fractures were classified according to the Intraoperative Vancouver system. We choosed 565 consecutive primary THAs performed by one surgeon between January 2006 and January. We went over all the operative reports and immediate post-operative radiographs to single out for study those fracture cases during operation. Demographic data of the patients were reviewed from the medical records including patient’age, sex, weight and height, so were operative reports, to determine the eccentric distance, distal diameter and length of the stems. We follow-up the all cases and analysis the date.Results Five type A1 fractures(11.6%), three type B1 fractures(6.9%), thirteen type B2 fractures(30.2%), six type A2 L fractures(13.9%), six type A2 G fractures(13.9%), eight type A3 L fractures(18.6%), two type A3 G fractures(4.6%) were recognized in the study. We used cerclage wiring or conservative treatment and complete an Harriss score after a mean period of 21.6 months(range: 12–37 months). All fractures healed uneventfully and none of them found implant migration or loosening by the X-ray until the end of the review. The mean Harrisscore was 85.21(range:77~91).Conclusions The incidence of intraoperative periprosthetic fracture during this study is 6.9% and most of them were non or minimally displaced. Female gender was absolutely associated and diameter of implant was significantly associated with intraoperative periprosthetic fractures,we used cerclage wiring to treated type A3 L and A3 G fractures in the operation and bear weight postponed for 2~3 monthes until fracture heling and obtain a favorable curative effect.