Intraoperative Fractures: Rising Problems

By Michael E. Berend, MD; Todd Bertrand, BA

ORTHOPEDICS 2007; 30:750
September 2007

All hip surgeons have had the experience of completing a primary total hip arthroplasty (THA) only to discover a proximal femoral fracture just prior to reducing the hip. We can comfort our patients and ourselves that the outcome of a THA with a proximal femoral fracture is excellent with proper treatment and uncemented stem fixation. The purpose of this study was to examine risk fractures, treatment options, and outcomes in THA with proximal femoral fractures.

Fracture Risk Factors

As the number of uncemented THAs has  increased,^1,2 there is no question the incidence of uncemented stem fractures has increased as as well.³ The risks for fracture during THA have been well studied. In their study, Schwartz et al⁴ found women were at higher risk for proximal femoral fracture with the AML stem (DePuy, Warsaw, Ind).

Changes in instrumentation and implantation have helped reduce the risk of fracture. Berend et al⁵ noted higher fracture rates in hips undergoing THA for a diagnosis other than osteoarthritis.