[Intraoperative femoral fractures during the implantation of the cementless BiCONTACT stem: a matched-pair analysis of 84 patients].
OBJECTIVE
Intraoperative periprosthetic femoral fractures (PFF) during the implantation of primary non-cemented total hip arthroplasties (THA) are an increasing problem. Thus, the goal of this study was to analyse the postoperative performance of primary non-cemented THA in patients with intraoperative PFFs, with respect to the patient's subjective health-related satisfaction.


METHODS
42 PFFs in 1216 primary THAs using the non-cemented BiCONTACT stem were monitored. Patients were compared to a control group of 42 non-cemented THA patients without intraoperative fracture complications, using the matched-pair analysis. Preoperative and after 2.2 years (0.8-3.2 years), patients were followed-up clinically and radiographically. Clinical parameters were Harris hip score, SF-36 health score, function and pain score and postoperative complications. Radiographic parameters were bone union, stem and trochanter migration. Fractures were graded using the Vancouver classification.


RESULTS
Results showed a significant increase in both Harris hip score and motion score and a significant decrease in pain score in both groups (p<0.001). The SF-36 health score increased significantly in nearly every dimension in both groups. Except for 2 patients with trochanter migrations of 25 and 20 mm, all fractures showed bony union. In 3 patients the stems subsided by 4.7 +/- 2.9 mm. The stems showed no further migration at final follow-up. 2 patients without intraoperative fractures underwent stem revision. Overall increases and postoperative complication rates were not significantly different between the groups.


CONCLUSIONS
Mid-term THA performance and patient satisfaction are not influenced by intraoperative Vancouver A and B1 fractures during implantation of the non-cemented BiCONTACT stem compared to a collective without intraoperative fractures during implantation.
Lerch
M
M
Orthopädische Klinik, Medizinische Hochschule Hannover, im Annastift e.V., Hannover. matthias.lerch@annastift.de
Windhagen
H
H
von Lewinski
G
G
Thorey
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D001864:Bone Wires; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging*; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology*; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D051346:Mobility Limitation; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000601:surgery*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation