Diagnosis and Management of Intraoperative Fractures in Primary Total Hip Arthroplasty

Ahmed Siddiqi, DO, MBA; Bryan D. Springer, MD; Antonia F. Chen, MD, MBA; Nicolas S. Piuzzi, MD

Disclosures

J Am Acad Orthop Surg. 2021;29(10):e497-e512. 

In This Article

Abstract and Introduction

Abstract

Intraoperative periprosthetic fractures are challenging complications that may affect implant stability and survivorship. Periprosthetic acetabular fractures are uncommon and infrequently are the focus of studies. Acetabular fractures are occasionally recognized after patients report unremitting groin pain weeks postoperatively. The widespread use of cementless acetabular cups might lead to higher number of fractures than is clinically detectable. Conversely, the incidence of intraoperative periprosthetic femoral fractures are more common and encompass a broad spectrum, ranging from a small cortical perforation to displaced fractures with an unstable prosthesis. Appropriate recognition, including mindfulness of preoperative patient and surgical risk factors, is critical to the successful management of acetabular and femoral complications. This comprehensive review article focuses on the incidence, patient and surgical risk factors, diagnosis, management, and clinical outcomes associated with intraoperative acetabular and femur fractures in primary total hip arthroplasty.

Introduction

Total hip arthroplasty (THA) is one of the most effective and successful procedures in reducing pain, restoring function, and improving a patient's overall quality of life.[1–3] Hence, the demand for primary THA has increased over the past 20 years and is projected to exponentially grow in the upcoming decade.[4–6] This is especially relevant because complications after THA are expected to concomitantly increase with the increase in procedural volume. Most complications associated with THA are uncommon, preventable if anticipated, and managed when recognized.[7]

Periprosthetic fractures (PPFx) are devastating complications related with an increase in other postoperative complications that may lead to worse clinical outcomes and increased mortality rates.[7] The prevalence of intraoperative PPFx (IPPFx) has increased in recent years with the increasing utilization of cementless implants.[8] Overall, appropriate recognition, including mindfulness of preoperative patient and surgical risk factors, is critical to the successful management of both acetabular and femoral intraoperative fractures. This comprehensive review article focuses on the incidence, patient and surgical risk factors, diagnosis, management, clinical outcomes, and cost associated with intraoperative acetabular and femur fractures in primary THA.

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