Lygrisse Katherine A, Gaukhman Gaukhman D, Teo Greg, Schwarzkopf Ran, Long William J, Aggarwal Vinay K
Department of Orthopedic Surgery, NYU Langone Health, New York, NY.
J Arthroplasty. 2021 Sep;36(9):3305-3311. doi: 10.1016/j.arth.2021.04.026. Epub 2021 Apr 27.
Periprosthetic femur fractures (PFF) involving primary total hip arthroplasty (THA) remain a significant concern. The purpose of this study was to evaluate the effect of surgical approach during primary THA on early PFF with respect to fracture timing, incidence, radiographic parameters, and surgery-related factors.
A retrospective review of all patients with PFF during or after primary THA from 2011 to 2019 was conducted at a single, urban academic institution. Of the study cohort of 11,915 patients, 79 patients with PFF were identified (0.66%). Direct anterior (DA), posterior anterior (PA), and laterally based (LA) cohorts were formed based on the surgical approach. PA and LA groups were combined to form a nonanterior (NA) cohort. Radiographic parameters, surgical factors, and fracture mechanism were analyzed.
The incidence of fracture across approaches was 0.70% (33/4707; DA), 0.63% (35/5600; PA), and 0.68% (11/1608; LA) (P = .97). Time from THA to fracture was significantly shorter in the DA cohort (12.5 ± 14.1 days) than the NA cohort (48.2 ± 120.6 days) (P = .05). Postoperatively identified, atraumatic PFFs were more common in the DA cohort (78.3%, 18/23) than the NA cohort (51.6%, 16/31) (P = .045). There were no differences between groups in radiographic or other clinical parameters.
Patients who underwent DA THA have significantly shorter time to PFF and were more often identified postoperatively with an atraumatic mechanism than patients who underwent NA approaches. The known difficulty in femoral exposure and stem placement with the DA approach may play a role in contributing to a higher rate of intraoperative or early postoperative PFF.
涉及初次全髋关节置换术（THA）的人工关节周围股骨骨折（PFF）仍然是一个重大问题。本研究的目的是评估初次THA手术入路对早期PFF在骨折时间、发生率、影像学参数和手术相关因素方面的影响。
在一家城市学术机构对2011年至2019年期间初次THA术中或术后所有PFF患者进行回顾性研究。在11915例研究队列患者中，确定了79例PFF患者（0.66%）。根据手术入路形成直接前路（DA）、后外侧入路（PA）和外侧入路（LA）队列。将PA组和LA组合并形成非前路（NA）队列。分析影像学参数、手术因素和骨折机制。
各入路的骨折发生率分别为0.70%（33/4707；DA）、0.63%（35/5600；PA）和0.68%（11/1608；LA）（P = .97）。DA队列中从THA到骨折的时间（12.5±14.1天）明显短于NA队列（48.2±120.6天）（P = .05）。术后发现，无创伤性PFF在DA队列中（78.3%，18/23）比NA队列中（51.6%，16/31）更常见（P = .045）。各组在影像学或其他临床参数方面无差异。
与接受NA入路的患者相比，接受DA THA的患者发生PFF的时间明显更短，且术后更常被确定为无创伤机制。DA入路在股骨暴露和假体柄置入方面已知的困难可能在导致术中或术后早期PFF发生率较高方面起作用。
