Cementless hip joint alloplasty complicated by intraoperative fracture of the femoral bone.

BACKGROUND

The aim of the study was to analyse the outcomes of hip replacement complicated by intraoperative femoral fractures and to analyse their effective management.

MATERIALS AND METHODS

The medical records of 43 cases of intraoperative femoral fractures (1.4% of all hip replacements) were retrospectively reviewed. The patient group included 29 females. Patients' age ranged from 20 to 66 years (mean age: 48.4 years). Follow-up duration ranged from 8 to 89 months (mean duration: 44 months).

RESULTS

There were 13 fractures of the greater trochanter, 21 fractures of the lesser trochanter involving the calcar, 7 at the implant stem level, and two below the implant stem. In 3 cases, the fracture was treated with a revision stem, with cerclage used in 17 other cases. In the remaining cases, the fractures were stable and did not require any internal fixation. Eighteen patients had very good final results, 19 had good and 6, fair results, according to Merle D'Aubigne- Postel's classification in Charnley's modification. None of our patients demonstrated evidence of stem loosening at the final follow-up.

CONCLUSIONS

Unstable intraoperative femoral fractures during a hip replacement procedure are rare and occur mostly in patients with post-dysplastic hips with a narrow intramedullary canal. In cases of stable fractures of the trochanter and calcar region, 12 weeks of partial weight bearing without additional immobilization is a sufficient approach. The final results are satisfactory in most cases of intraoperative femoral fractures.