Foissey Constant, Kenney Raymond, Luceri Francesco, Servien Elvire, Lustig Sébastien, Batailler Cécile
Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Center of Excellence, Croix-Rousse Hospital, 103 Grande rue de la Croix-Rousse, Rhône-Alpes, 69004, Lyon, France.
Department of Orthopaedics, University of Rochester Medical Center, 4901 Lac De Ville Blvd Building D, Rochester, NY, 14618, USA.
Arch Orthop Trauma Surg. 2021 Apr;141(4):675-681. doi: 10.1007/s00402-020-03710-1. Epub 2021 Jan 8.
Greater trochanter (GT) fractures affect 0.6-29% of patients after direct anterior approach (DAA) total hip arthroplasty (THA). Given the growing popularity of this approach, this study aimed to assess the evolution of the GT fractures during the learning curve, their risk factors and their consequences.
537 total hip arthroplasties were retrospectively included from May 2013 to December 2017 in a single academic centre. Patient characteristics, perioperative management, clinical consequences and postoperative radiographs were analysed.
GT fractures represented 2.4% (n = 13) of the THA, and there was not a decrease with experience. The GT fracture patients did not require any additional support during the surgery, and full weight bearing was always allowed without any restriction. This complication only happened in females, with the risk significantly increased in those > 70 years old (OR = 4.9). There was no specific consequence during the follow-up, mean HHS score was 98.5 and all of the patients were satisfied or very satisfied postoperatively.
Older osteoporotic women are known to be at risk for GT fracture during DAA THA. Those results reinforce the argument in favour of proper patient selection in DAA to lower the complications since it does not improve with surgeon's experience.
Retrospective, consecutive case series; Level IV.
在直接前路（DAA）全髋关节置换术（THA）后，大转子（GT）骨折影响0.6%-29%的患者。鉴于这种手术方式越来越受欢迎，本研究旨在评估学习曲线期间GT骨折的演变、其危险因素及其后果。
回顾性纳入2013年5月至2017年12月在单一学术中心进行的537例全髋关节置换术。分析患者特征、围手术期管理、临床后果和术后X线片。
GT骨折占THA的2.4%（n = 13），且并未随经验的增加而减少。GT骨折患者在手术期间不需要任何额外支持，始终允许完全负重且无任何限制。这种并发症仅发生在女性中，70岁以上女性风险显著增加（OR = 4.9）。随访期间没有特殊后果，平均HHS评分为98.5，所有患者术后均满意或非常满意。
已知老年骨质疏松女性在DAA THA期间有发生GT骨折的风险。这些结果强化了在DAA中进行适当患者选择以降低并发症的观点，因为这并不会随着外科医生经验的增加而改善。
回顾性连续病例系列；IV级。
