title: Femur fractures associated with canine total hip replacement.
abstract: OBJECTIVE
  To report femur fracture as a complication of canine total hip replacement (THR) and to report the incidence, predisposing factors, treatment options, and outcome.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  Twenty-two client-owned dogs with 24 femoral fractures occurring during or after THR.
  
  
  METHODS
  Cemented THR (BioMedtrix, Boonton, NJ) was performed. Medical records and radiographs were used to identify dogs that had femur fracture and to identify risk factors. Follow-up was obtained until dog death or study end.
  
  
  RESULTS
  The overall incidence of femur fracture after THR was 2.9%. Femoral fractures occurred intraoperatively, immediately postoperatively, and up to 2196 days after THR. In 17 dogs, fractures resulted from a traumatic event. Osteopathy was present at THR in 5 dogs; all developed femoral fissures during reaming. Three dogs had fractures associated with cortical thinning secondary to aseptic loosening. Fracture treatment included euthanasia (1 dog), strict confinement (3 dogs), full cerclage wires on long oblique fractures (3 dogs), or plate and screw fixation (10 with, and 7 without, cerclage wires). All fractures extended near the distal tip of the femoral stem and all aggressively treated fractures healed.
  
  
  CONCLUSIONS
  Predisposing risk factors for femur fracture after THR include osteopathy and iatrogenic fissures created during reaming. Trauma, excessive load concentration, and increased torque can lead to mid-diaphyseal fracture near the end of the femoral stem. Fracture did not disrupt THR implants. Cement fracture exposing the tip of the femoral stem did not affect fracture healing or rehabilitation. Immediate plate and screw fixation resulted in the most favorable outcome; healing occurred in 6-10 weeks.
  
  
  CONCLUSIONS
  Femur fractures that occur after THR should be repaired using plate and screw fixation augmented with cerclage wire when needed. Forces on fissures should be neutralized to prevent propagation and fracture. Owners of high-risk patients (old dogs with osteopathies or previous hip surgery) should be counseled before THR. The prognosis is excellent when fractures are treated correctly.
authors.affiliation: Gulf Coast Veterinary Specialists, 1111 West Loop South, Houston, TX 77027, USA. Billliska@aol.com
authors.forename: William D
authors.initials: WD
authors.lastname: Liska
mesh_terms: D000818:Animals; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000662:veterinary*; D001860:Bone Plates / Q000662:veterinary; D004283:Dog Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D004285:Dogs; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology / Q000209:etiology / Q000662:veterinary*; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data / Q000662:veterinary; D015994:Incidence; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D011996:Records / Q000662:veterinary; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology