Thillemann Theis M, Pedersen Alma B, Johnsen Søren P, Søballe Kjeld
Department of Orthopedics, Aarhus University Hospital, Denmark.
Acta Orthop. 2008 Jun;79(3):327-34. doi: 10.1080/17453670710015210.
Intraoperative femoral fracture is a well known complication of primary total hip arthroplasty (THA). Experimental studies have indicated that intraoperative fractures may affect implant survival. Very few clinical data are available, however.
We used data from the Danish Hip Arthroplasty Registry to identify patients in Denmark who underwent a primary THA due to primary osteoarthritis between 1995 and 2005 (n = 39,478). Data were linked to two national Danish databases in order to conduct time-dependent implant survival analyses. Implant survival and relative risk estimates were calculated for patients treated nonoperatively and for patients treated with osteosynthesis after sustaining intraoperative femoral fractures during THA surgery. THAs performed without sustaining intraoperative femoral fracture served as the reference group.
282 patients (0.7%) were treated non operatively due to intraoperative femoral fracture and 237 patients (0.6%) were treated with osteosynthesis. In the 0-6 month postoperative period, the adjusted relative risk (RR) of revision was 1.5 (95% CI: 1.1-1.7) for patients treated nonoperatively and 5.7 (3.3-10) for patients treated with osteosynthesis. In the period from 6 months to 11 years postoperatively, we did not find any statistically significant differences in the RR of revision between the groups.
Intraoperative fractures increase the relative risk of revision during the first 6 postoperative months. Thus, patients should be informed about the risk of revision after sustaining an intraoperative femoral fracture. Furthermore, initiatives aimed at reducing the risk of revision in the first 6 months following THA should be considered in patients with intraoperative fractures, including immediate change to a larger stem with distal fixation and restricted weight bearing.
术中股骨骨折是初次全髋关节置换术（THA）一种广为人知的并发症。实验研究表明，术中骨折可能影响植入物的存活。然而，临床数据非常有限。
我们使用丹麦髋关节置换登记处的数据，确定1995年至2005年间在丹麦因原发性骨关节炎接受初次THA的患者（n = 39478）。数据与两个丹麦国家数据库相关联，以便进行时间依赖性植入物存活分析。计算了在THA手术中发生术中股骨骨折后接受非手术治疗的患者以及接受骨固定治疗的患者的植入物存活率和相对风险估计值。未发生术中股骨骨折的THA作为参照组。
282例患者（0.7%）因术中股骨骨折接受非手术治疗，237例患者（0.6%）接受骨固定治疗。在术后0至6个月期间，非手术治疗患者翻修的调整相对风险（RR）为1.5（95%CI：1.1 - 1.7），骨固定治疗患者为5.7（3.3 - 10）。在术后6个月至11年期间，我们未发现两组之间翻修RR有任何统计学上的显著差异。
术中骨折会增加术后前6个月翻修的相对风险。因此，应告知患者术中发生股骨骨折后有翻修风险。此外，对于术中骨折的患者，应考虑采取旨在降低THA后前6个月翻修风险的措施，包括立即更换为更大的带远端固定的柄并限制负重。
