Colacchio Nicholas D, Robbins Claire E, Aghazadeh Mehran S, Talmo Carl T, Bono James V
Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts.
J Arthroplasty. 2017 Oct;32(10):3163-3168. doi: 10.1016/j.arth.2017.05.012. Epub 2017 May 15.
Intraoperative femur fracture (IFF) is a well-known complication in primary uncemented total hip arthroplasty (THA). Variations in implant instrumentation design and operative technique may influence the risk of IFF. This study investigates IFF between a standard uncemented tapered-wedge femoral stem and its second-generation successor with the following design changes: size-specific medial curvature, proportional incremental stem growth, modest reduction in stem length, and distal lateral relief.
A single experienced surgeon's patient database was retrospectively queried for IFF occurring during primary uncemented THA using a standard tapered-wedge femoral stem system or a second-generation stem. All procedures were performed using soft tissue preserving anatomic capsule repair and posterior approach. The primary outcome measure was IFF. A z-test of proportions was performed to determine significant difference between the 2 stems with respect to IFF. Patient demographics, Dorr classification, and implant characteristics were also examined.
Forty-one of 1510 patients (2.72%) who received a standard tapered-wedge femoral stem sustained an IFF, whereas 5 of 800 patients (0.63%) using the second-generation stem incurred an IFF. No other significant associations were found.
A standard tapered-wedge femoral stem instrumentation system resulted in greater than 4 times higher incidence of IFF than its second-generation successor used for primary uncemented THA. Identifying risk factors for IFF is necessary to facilitate implant system improvements and thus maximize patient outcomes.
术中股骨骨折（IFF）是初次非骨水泥型全髋关节置换术（THA）中一种广为人知的并发症。植入器械设计和手术技术的差异可能会影响IFF的风险。本研究调查了标准非骨水泥型锥形楔形股骨柄与其第二代产品之间的IFF情况，第二代产品有以下设计变化：特定尺寸的内侧曲率、成比例的渐进式柄增长、柄长度适度缩短以及远端外侧减压。
回顾性查询一位经验丰富的外科医生的患者数据库，以获取在初次非骨水泥型THA期间使用标准锥形楔形股骨柄系统或第二代柄时发生的IFF情况。所有手术均采用保留软组织的解剖学囊修复和后入路。主要结局指标是IFF。进行比例z检验以确定两种柄在IFF方面的显著差异。还检查了患者人口统计学、Dorr分类和植入物特征。
1510例接受标准锥形楔形股骨柄的患者中有41例（2.72%）发生了IFF，而使用第二代柄的800例患者中有5例（0.63%）发生了IFF。未发现其他显著关联。
对于初次非骨水泥型THA，标准锥形楔形股骨柄器械系统导致IFF的发生率比其第二代产品高出4倍以上。识别IFF的风险因素对于促进植入系统改进从而使患者预后最大化是必要的。
