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European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

07.05.2018 | Original Article • HIP - ARTHROPLASTY

High incidence of intraoperative calcar fractures with the cementless CLS Spotorno stem

verfasst von: Carla Timmer, Davey M. J. M. Gerhardt, Enrico de Visser, Marinus de Kleuver, Job L. C. van Susante

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 7/2018

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Abstract

Introduction

This study reports on the incidence of intraoperative calcar fractures with the cementless Spotorno (CLS) stem, and the potential role of a learning curve and implant positioning is investigated.

Methods

After introduction of the CLS stem, 800 consecutive cementless total hip arthroplasties (THA) were analyzed. The incidence of calcar fracture in the first 400 THA was compared with the second 400 THA, in order to study a potential learning curve effect. According to the instruction for users, varus positioning of the stem was avoided and a femoral neck osteotomy was aimed relatively close to the lesser trochanter since these are assumed to be correlated with calcar fractures. Implant positioning (neck-shaft angle, femoral offset and osteotomy-lesser trochanter distance) was measured on postoperative pelvic radiographs of all THA with calcar fractures and 100 randomly selected uncomplicated control cases.

Results

Seventeen (2.1%) intraoperative calcar fractures were recorded. The incidence of calcar fracture differed between the first 400 THA (n = 11) and the second 400 THA (n = 6). This difference was not statistically significant (p = 0.220); however, these numbers indicate a trend toward a learning effect. No significant difference in stem positioning nor the height of the femoral neck osteotomy was measured between THA with a calcar fracture (n = 17) and the control cases (n = 100).

Conclusions

We report on a high incidence of intraoperative calcar fractures with the use of a CLS stem. The risk for calcar fractures remains clinically significant even after adequate implant positioning in the hands of experienced hip surgeons. Surgeons should be aware of this implant related phenomenon and be alert on this phenomenon intraoperatively.

Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370(9597):1508–1519CrossRefPubMed

Bourne RB et al (2001) Tapered titanium cementless total hip replacements: a 10- to 13-year followup study. Clin Orthop Relat Res 393:112–120CrossRef

Berend KR, Lombardi AV Jr (2010) Intraoperative femur fracture is associated with stem and instrument design in primary total hip arthroplasty. Clin Orthop Relat Res 468(9):2377–2381CrossRefPubMedPubMedCentral

Biemond JE, Venkatesan S, van Hellemondt GG (2015) Survivorship of the cementless Spotorno femoral component in patients under 50 years of age at a mean follow-up of 18.4 years. Bone Jt J 97-B(2):160–163CrossRef

Sadoghi P et al (2013) Pooled outcome of total hip arthroplasty with the CementLess Spotorno (CLS) system: a comparative analysis of clinical studies and worldwide arthroplasty register data. Int Orthop 37(6):995–999CrossRefPubMedPubMedCentral

Hwang KT et al (2012) Total hip arthroplasty using cementless grit-blasted femoral component: a minimum 10-year follow-up study. J Arthroplasty 27(8):1554–1561CrossRefPubMed

Aldinger PR et al (2003) A ten- to 15-year follow-up of the cementless Spotorno stem. J Bone Jt Surg Br 85(2):209–214CrossRef

Miettinen SS et al (2016) Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty. Acta Orthop 87(2):113–119CrossRefPubMed

Cameron HU (2004) Intraoperative hip fractures: ruining your day. J Arthroplasty 19(4 Suppl 1):99–103CrossRefPubMed

10.

Ponzio DY et al (2015) Intraoperative proximal femoral fracture in primary cementless total hip arthroplasty. J Arthroplasty 30(8):1418–1422CrossRefPubMed

11.

Berry DJ (1999) Epidemiology: hip and knee. Orthop Clin North Am 30(2):183–190CrossRefPubMed

12.

Min BW et al (2008) The effect of stem alignment on results of total hip arthroplasty with a cementless tapered-wedge femoral component. J Arthroplasty 23(3):418–423CrossRefPubMed

13.

Kim YH, Park KC, Hwang KT, Choi IY (2004) Hydroxyapatite coated CLS femoral stem in patients with rheumatoid arthritis: minimum 5 year results. J Korean Orthop Assoc 39(4):347–353CrossRef

14.

Sidler-Maier CC, Waddell JP (2015) Incidence and predisposing factors of periprosthetic proximal femoral fractures: a literature review. Int Orthop 39(9):1673–1682CrossRefPubMed

15.

Mollan RA et al (1984) Failure of the femoral component in the Howse total hip arthroplasty. Clin Orthop Relat Res 190:142–147

16.

Witjes S et al (2009) Learning from the learning curve in total hip resurfacing: a radiographic analysis. Arch Orthop Trauma Surg 129(10):1293–1299CrossRefPubMed

17.

Callaghan JJ et al (1992) Evaluation of the learning curve associated with uncemented primary porous-coated anatomic total hip arthroplasty. Clin Orthop Relat Res 282:132–144

18.

Berend ME et al (2006) Long-term outcome and risk factors of proximal femoral fracture in uncemented and cemented total hip arthroplasty in 2551 hips. J Arthroplasty 21(6 Suppl 2):53–59CrossRefPubMed

19.

Moroni A et al (2000) Risk factors for intraoperative femoral fractures during total hip replacement. Ann Chir Gynaecol 89(2):113–118PubMed

20.

Carli AV, Negus JJ, Haddad FS (2017) Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture? Bone Jt J 99-B(1 Supple A):50–59CrossRef

21.

Mayle RE, Della Valle CJ (2012) Intra-operative fractures during THA: see it before it sees us. J Bone Jt Surg Br 94(11 Suppl A):26–31CrossRef

22.

Davidson D et al (2008) Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Jt Surg Am 90(9):2000–2012CrossRef

23.

Berend KR et al (2004) Cerclage wires or cables for the management of intraoperative fracture associated with a cementless, tapered femoral prosthesis: results at 2–16 years. J Arthroplasty 19(7 Suppl 2):17–21CrossRefPubMed

24.

Sharkey PF et al (1992) Intraoperative femoral fractures in cementless total hip arthroplasty. Orthop Rev 21(3):337–342PubMed

25.

Bonnin MP et al (2015) Increased incidence of femoral fractures in small femurs and women undergoing uncemented total hip arthroplasty—Why? Bone Jt J 97-B(6):741–748CrossRef

26.

Toni A et al (1994) Incidence of intraoperative femoral fracture. Straight-stemmed versus anatomic cementless total hip arthroplasty. Acta Orthop Belg 60(1):43–54PubMed

27.

Jasty M et al (1992) Unrecognized femoral fractures during cementless total hip arthroplasty in the dog and their effect on bone ingrowth. J Arthroplasty 7(4):501–508CrossRefPubMed

Titel: High incidence of intraoperative calcar fractures with the cementless CLS Spotorno stem
verfasst von: Carla Timmer
Davey M. J. M. Gerhardt
Enrico de Visser
Marinus de Kleuver
Job L. C. van Susante
Publikationsdatum: 07.05.2018
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 7/2018
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-018-2217-8

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Abstract

Introduction

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Conclusions

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