Download PDF
The Journal of Hip Surgery 2020; 04(01): 033-037
DOI: 10.1055/s-0040-1708538
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Perioperative Fracture Risk and Two-Year Survivorship of a Short Tapered Femoral Stem following Direct Anterior Approach Cementless Total Hip Arthroplasty with a Fracture Table

Samantha Andrews 
1   Bone and Joint Center, Straub Medical Center, Honolulu, Hawaii
2   Department of Surgery, University of Hawai'i at Manoa, Honolulu, Hawaii
,
Gregory J. Harbison
3   John A. Burns School of Medicine, Honolulu, Hawaii
,
Ian Hasegawa
2   Department of Surgery, University of Hawai'i at Manoa, Honolulu, Hawaii
,
Emily Unebasami
1   Bone and Joint Center, Straub Medical Center, Honolulu, Hawaii
4   Department of Neuroscience and Behavior, University of Notre Dame, Notre Dame, Indiana
,
Cass Nakasone
1   Bone and Joint Center, Straub Medical Center, Honolulu, Hawaii
2   Department of Surgery, University of Hawai'i at Manoa, Honolulu, Hawaii
› Author Affiliations
Further Information

Publication History

06 December 2019

04 February 2020

Publication Date:
23 March 2020 (online)

    Permissions and Reprints

Abstract

The cementless, tapered wedge, short femoral stem implant is commonly used in direct anterior approach (DAA) total hip arthroplasty (THA). The lack of access and visualization, however, may increase the risk of perioperative fracture and early failure. Therefore, the current study examined perioperative complications and 2-year implant survivorship following DAA THA performed using a fracture table and short, tapered wedge femoral stem. A retrospective analysis was conducted on patients having undergone DAA THA with a cementless, tapered wedge, short femoral stem. Perioperative fractures were noted and survivorship was determined by the incidence of revision surgery within a minimum 2-year follow-up period. A total 366 consecutive patients (441 hips) were identified in the cohort. Four patients (6 hips; 1.4%) were lost to follow-up and three patients died from unrelated causes. Average follow-up time for the remaining 359 patients (435 hips) was 32.9 ± 10.2 months. There were no intraoperative factures but three perioperative fractures within two weeks. Aseptic loosening occurred in one stem at 13 months, resulting in a 99.1% survival rate with a mean survival time of 23.8 ± 0.1 months (95% confidence interval: 23.6–24.0 months). The use of a short, tapered wedge femoral stem and a fracture table for DAA THA resulted in 0.7% periprosthetic fractures and only one aseptic loosening within 2 years. These results suggest that proper femoral exposure with the use of a fracture table and a short, tapered wedge femoral stem does not appear to increase the risk of periprosthetic femoral fracture.

Keywords

survivorship - total hip arthroplasty - direct anterior approach - short stem - tapered wedge stem - fracture table
 

  • References

  • 1 Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 2005; 441 (441) 115-124
    CrossrefPubMedGoogle Scholar
  • 2 Kennon RE, Keggi JM, Wetmore RS, Zatorski LE, Huo MH, Keggi KJ. Total hip arthroplasty through a minimally invasive anterior surgical approach. J Bone Joint Surg Am 2003; 85-A (Suppl. 04) 39-48
    PubMedGoogle Scholar
  • 3 Cidambi KR, Barnett SL, Mallette PR, Patel JJ, Nassif NA, Gorab RS. Impact of femoral stem design on failure after anterior approach total hip arthroplasty. J Arthroplasty 2018; 33 (03) 800-804
    CrossrefPubMedGoogle Scholar
  • 4 Panichkul P, Parks NL, Ho H, Hopper Jr RH, Hamilton WG. New approach and stem increased femoral revision rate in total hip arthroplasty. Orthopedics 2016; 39 (01) e86-e92
    CrossrefPubMedGoogle Scholar
  • 5 Dietrich M, Kabelitz M, Dora C, Zingg PO. Perioperative fractures in cementless total hip arthroplasty using the direct anterior minimally invasive approach: reduced risk with short stems. J Arthroplasty 2018; 33 (02) 548-554
    CrossrefPubMedGoogle Scholar
  • 6 Tamaki T, Jonishi K, Miura Y, Oinuma K, Shiratsuchi H. Cementless tapered-wedge stem length affects the risk of periprosthetic femoral fractures in direct anterior total hip arthroplasty. J Arthroplasty 2018; 33 (03) 805-809
    CrossrefPubMedGoogle Scholar
  • 7 Parvizi J, Keisu KS, Hozack WJ, Sharkey PF, Rothman RH. Primary total hip arthroplasty with an uncemented femoral component: a long-term study of the Taperloc stem. J Arthroplasty 2004; 19 (02) 151-156
    CrossrefPubMedGoogle Scholar
  • 8 McLaughlin JR, Lee KR. Total hip arthroplasty with an uncemented tapered femoral component. J Bone Joint Surg Am 2008; 90 (06) 1290-1296
    CrossrefPubMedGoogle Scholar
  • 9 Rao RR, Sharkey PF, Hozack WJ, Eng K, Rothman RH. Immediate weightbearing after uncemented total hip arthroplasty. Clin Orthop Relat Res 1998; (349) 156-162
    PubMedGoogle Scholar
  • 10 Cooper HJ, Jacob AP, Rodriguez JA. Distal fixation of proximally coated tapered stems may predispose to a failure of osteointegration. J Arthroplasty 2011; 26 (6, Suppl): 78-83
    CrossrefPubMedGoogle Scholar
  • 11 Hartford JM, Graw BP, Knowles SB, Frosch DL. Isolated greater trochanteric fracture and the direct anterior approach using a fracture table. J Arthroplasty 2018; 33 (7S): S253-S258
    CrossrefPubMedGoogle Scholar
  • 12 Masonis J, Thompson C, Odum S. Safe and accurate: learning the direct anterior total hip arthroplasty. Orthopedics 2008 31. (12, Suppl 2): orthosupersite.com/view.asp?rID=37187
    PubMedGoogle Scholar
  • 13 Jewett BA, Collis DK. High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res 2011; 469 (02) 503-507
    CrossrefPubMedGoogle Scholar
  • 14 Woolson ST, Pouliot MA, Huddleston JI. Primary total hip arthroplasty using an anterior approach and a fracture table: short-term results from a community hospital. J Arthroplasty 2009; 24 (07) 999-1005
    CrossrefPubMedGoogle Scholar
  • 15 Hartford JM, Knowles SB. Risk factors for perioperative femoral fractures: cementless femoral implants and the direct anterior approach using a fracture table. J Arthroplasty 2016; 31 (09) 2013-2018
    CrossrefPubMedGoogle Scholar
  • 16 Barnett SL, Peters DJ, Hamilton WG, Ziran NM, Gorab RS, Matta JM. Is the anterior approach safe? Early complication rate associated with 5090 consecutive primary total hip arthroplasty procedures performed using the anterior approach. J Arthroplasty 2016; 31 (10) 2291-2294
    CrossrefPubMedGoogle Scholar
  • 17 Seng BE, Berend KR, Ajluni AF, Lombardi Jr AV. Anterior-supine minimally invasive total hip arthroplasty: defining the learning curve. Orthop Clin North Am 2009; 40 (03) 343-350
    CrossrefPubMedGoogle Scholar
  • 18 Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty 2009; 24 (05) 698-704
    CrossrefPubMedGoogle Scholar
  • 19 Berend KR, Mirza AJ, Morris MJ, Lombardi Jr AV. Risk of periprosthetic fractures with direct anterior primary total hip arthroplasty. J Arthroplasty 2016; 31 (10) 2295-2298
    CrossrefPubMedGoogle Scholar
  • 20 Cohen EM, Vaughn JJ, Ritterman SA, Eisenson DL, Rubin LE. Intraoperative femur fracture risk during primary direct anterior approach cementless total hip arthroplasty with and without a fracture table. J Arthroplasty 2017; 32 (09) 2847-2851
    CrossrefPubMedGoogle Scholar
  • 21 Mirza AJ, Lombardi Jr AV, Morris MJ, Berend KR. A mini-anterior approach to the hip for total joint replacement: optimising results: improving hip joint replacement outcomes. Bone Joint J 2014; 96-B (11, Supple A): 32-35
    CrossrefPubMedGoogle Scholar
  • 22 Berend KR, Lombardi Jr AV. Intraoperative femur fracture is associated with stem and instrument design in primary total hip arthroplasty. Clin Orthop Relat Res 2010; 468 (09) 2377-2381
    CrossrefPubMedGoogle Scholar
  • 23 Berend KR, Lombardi Jr AV, Seng BE, Adams JB. Enhanced early outcomes with the anterior supine intermuscular approach in primary total hip arthroplasty. J Bone Joint Surg Am 2009; 91 (Suppl. 06) 107-120
    PubMedGoogle Scholar
  • 24 Greco NJ, Lombardi Jr AV, Morris MJ, Hobbs GR, Berend KR. Direct anterior approach and perioperative fracture with a single-taper wedge femoral component. J Arthroplasty 2019; 34 (01) 145-150
    CrossrefPubMedGoogle Scholar
  • 25 Eto S, Hwang K, Huddleston JI, Amanatullah DF, Maloney WJ, Goodman SB. The direct anterior approach is associated with early revision total hip arthroplasty. J Arthroplasty 2017; 32 (03) 1001-1005
    CrossrefPubMedGoogle Scholar
  • 26 Meneghini RM, Elston AS, Chen AF, Kheir MM, Fehring TK, Springer BD. Direct anterior approach: risk factor for early femoral failure of cementless total hip arthroplasty: a multicenter study. J Bone Joint Surg Am 2017; 99 (02) 99-105
    CrossrefPubMedGoogle Scholar
  • 27 Angerame MR, Fehring TK, Masonis JL, Mason JB, Odum SM, Springer BD. Early failure of primary total hip arthroplasty: is surgical approach a risk factor?. J Arthroplasty 2018; 33 (06) 1780-1785
    CrossrefPubMedGoogle Scholar
  • 28 Sheth D, Cafri G, Inacio MC, Paxton EW, Namba RS. Anterior and anterolateral approaches for THA are associated with lower dislocation risk without higher revision risk. Clin Orthop Relat Res 2015; 473 (11) 3401-3408
    CrossrefPubMedGoogle Scholar