Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.
Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
J Orthop Traumatol. 2024 Nov 4;25(1):51. doi: 10.1186/s10195-024-00795-x.
The pelvic and femoral morphology are associated with the occurrence of early periprosthetic femoral fractures (PFFs) in cementless total hip arthroplasty (THA). Differences exist depending on the performed approach and implanted stem design. Therefore, this study was conducted to analyze the pelvic and femoral morphology in cementless short stem THA via a minimally-invasive (MIS) anterolateral approach.
A retrospective, single-center, multi-surgeon, comparative propensity-score matched study of a cohort of 1826 short stem THAs was conducted. A total of 39 PFFs within the first 90 days after surgery was matched on a 2:1 ratio to non-fracture patients. The morphology of the proximal femur was analyzed with canal flare index (CFI), canal-calcar ratio (CCR), canal-bone ratio (CBR), morphological cortical index (MCI), and femoral cortical index (CI). The pelvic morphology was analyzed with ilium-ischial ratio (IR), distance anterior superior iliac spine to the tip of the greater trochanter (AGT). Both groups were analyzed regarding several parameters for femoral and pelvic morphology in non-parametric testing and univariate regression analysis.
A significantly higher AGT was detected in the fracture group (104.5 mm ± 18 versus 97.4 mm ± 9.8; p = 0.016). All other femoral and pelvic parameters did not differ between both groups, also when compared depending on the Vancouver type of the PFF.
The morphology of the proximal femur and the pelvis do not differ in several radiological parameters in patients sustaining a PFF in cementless short stem THA via an anterolateral approach compared with matched non-fracture group. The findings are controversial to other studies with different stem types and approaches. Future studies should focus on analyzing the influence of the pelvic geometry and the shape of the proximal femur in the occurrence of PFFs in different approaches with the same stem type and vice versa. Level of Evidence Level III case-controlled study.
骨盆和股骨形态与非骨水泥全髋关节置换术（THA）中早期假体周围股骨骨折（PFF）的发生有关。根据所采用的入路和植入物设计，存在差异。因此，本研究旨在通过微创（MIS）前外侧入路分析非骨水泥短柄 THA 的骨盆和股骨形态。
回顾性、单中心、多外科医生、比较倾向评分匹配研究了 1826 例短柄 THA 队列。在手术后 90 天内共发生 39 例 PFF，按照 2:1 的比例与非骨折患者相匹配。采用管腔扩张指数（CFI）、管腔-小粗隆比（CCR）、管腔-骨比（CBR）、形态皮质指数（MCI）和股骨皮质指数（CI）分析股骨近端形态。采用髂骨-坐骨比（IR）、坐骨上棘前缘至大转子尖端的距离（AGT）分析骨盆形态。对两组患者进行股骨和骨盆形态的几个参数进行非参数检验和单因素回归分析。
骨折组的 AGT 明显较高（104.5 ± 18 毫米比 97.4 ± 9.8 毫米；p = 0.016）。两组患者在其他股骨和骨盆参数方面无差异，当根据 PFF 的温哥华分型进行比较时也是如此。
与匹配的非骨折组相比，通过前外侧入路进行非骨水泥短柄 THA 的患者在发生 PFF 时，股骨近端和骨盆的几个影像学参数的形态没有差异。这些发现与其他具有不同柄类型和入路的研究结果相反。未来的研究应侧重于分析不同入路中骨盆几何形状和股骨近端形状对不同柄类型和反之亦然 PFF 发生的影响。
III 级病例对照研究。
