Gordon Dan, Cardenas Justin M, Fawley David, Kitziger Kurt J, Gladnick Brian P
Baylor University Medical Center, 3500 Gaston Ave, 6th Floor Hoblitzelle, Dallas, TX 75246, USA.
W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, 9301 N. Central Expressway, Tower I, Suite 400, Dallas, TX, 75231, USA.
J Orthop. 2024 Aug 5;59:64-67. doi: 10.1016/j.jor.2024.08.002. eCollection 2025 Jan.
Automated broaching has recently been introduced for total hip arthroplasty (THA), with the goal of improving surgical efficiency and reducing surgeon workload. While studies have suggested that this technique may improve femoral sizing and alignment, little has been published regarding its safety, particularly with regard to calcar fractures. The purpose of our study was to evaluate the risk of calcar fracture during automated broaching, and to determine if this risk can be mitigated.
We queried our prospective institutional database and identified 1596 unilateral THAs performed by the senior author using automated impaction between 2019 and 2023. We identified the incidence of calcar fracture with automated impaction, and whether the fracture occurred during broaching or stem insertion. We additionally determined calcar fracture incidence within two consecutive subgroups of patients using different stem insertion techniques; subgroup (1): automated broaching with automated stem insertion for all patients; versus subgroup (2): automated broaching with automated stem insertion ONLY if a cushion of cancellous bone separated the broach from the calcar, otherwise the stem was placed manually. Continuous and categorical variables were analyzed with Student's t-test and Fisher's exact test, respectively.
Seventeen calcar fractures occurred intraoperatively (1.1 %). Only two fractures occurred during automated broaching (0.1 %), while fifteen occurred during final stem impaction (0.9 %) (p = 0.007). Four calcar fractures (1.4 %) occurred in subgroup 1, compared to two in subgroup 2 (0.6 %) (p = 0.28).
Our study found a calcar fracture incidence of 1.1 % using automated impaction, consistent with historically reported rates of 0.4-3.7 %. We found that calcar fractures are more likely to occur during stem insertion than during femoral broaching. We recommend that if any part of the final broach is in direct contact with the calcar, the final stem should be impacted manually to minimize fracture risk.
自动扩髓技术最近已被引入全髋关节置换术（THA），目的是提高手术效率并减轻外科医生的工作量。虽然研究表明该技术可能会改善股骨尺寸和对线，但关于其安全性的报道较少，尤其是关于股骨距骨折方面。我们研究的目的是评估自动扩髓过程中股骨距骨折的风险，并确定该风险是否可以减轻。
我们查询了前瞻性机构数据库，确定了2019年至2023年间由资深作者使用自动冲击技术进行的1596例单侧全髋关节置换术。我们确定了自动冲击时股骨距骨折的发生率，以及骨折是在扩髓过程中还是在柄插入过程中发生。我们还确定了使用不同柄插入技术的两个连续患者亚组中的股骨距骨折发生率；亚组（1）：所有患者均采用自动扩髓和自动柄插入；与亚组（2）：仅当松质骨垫将扩髓器与股骨距分开时才采用自动扩髓和自动柄插入，否则手动放置柄。连续变量和分类变量分别采用学生t检验和Fisher精确检验进行分析。
术中发生17例股骨距骨折（1.1%）。仅2例骨折发生在自动扩髓过程中（0.1%），而15例发生在最终柄冲击过程中（0.9%）（p = 0.007）。亚组1中发生4例股骨距骨折（1.4%），而亚组2中发生2例（0.6%）（p = 0.28）。
我们的研究发现，使用自动冲击技术时股骨距骨折发生率为1.1%，与历史报道的0.4 - 3.7%的发生率一致。我们发现股骨距骨折在柄插入过程中比在股骨扩髓过程中更易发生。我们建议，如果最终扩髓器的任何部分与股骨距直接接触，应手动冲击最终柄以将骨折风险降至最低。
