title: Increased incidence of femoral fractures in small femurs and women undergoing uncemented total hip arthroplasty - why?
abstract: The aim of this study was to investigate the relationship between the geometry of the proximal femur and the incidence of intra-operative fracture during uncemented total hip arthroplasty (THA). We studied the pre-operative CT scans of 100 patients undergoing THA with an uncemented femoral component. We measured the anteroposterior and mediolateral dimensions at the level of division of the femoral neck to calculate the aspect ratio of the femur. Wide variations in the shape of the femur were observed, from round, to very narrow elliptic. The femurs of women were narrower than those of men (p < 0.0001) and small femurs were also narrower than large ones. Patients with an intra-operative fracture of the calcar had smaller and narrower femurs than those without a fracture (p < 0.05) and the implanted Corail stems were smaller in those with a fracture (mean size 9 vs 12, p < 0.0001). The variability of the shape of the femoral neck at the level of division contributes to the understanding of the causation of intra-operative fractures in uncemented THA.
authors.affiliation: Centre Orthopédique Santy, 24 Av Paul Santy, 69008 Lyon, France.
authors.forename: M P
authors.initials: MP
authors.lastname: Bonnin
authors.affiliation: Centre Orthopédique Santy, 24 Av Paul Santy, 69008 Lyon, France.
authors.forename: C C
authors.initials: CC
authors.lastname: Neto
authors.affiliation: Centre Orthopédique Santy, 24 Av Paul Santy, 69008 Lyon, France.
authors.forename: T
authors.initials: T
authors.lastname: Aitsiselmi
authors.affiliation: Centre Orthopédique Santy, 24 Av Paul Santy, 69008 Lyon, France.
authors.forename: C G
authors.initials: CG
authors.lastname: Murphy
authors.affiliation: Hospices Civils de Lyon, F-69003 Lyon, France.
authors.forename: N
authors.initials: N
authors.lastname: Bossard
authors.affiliation: Hospices Civils de Lyon, F-69003 Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Roche
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology* / Q000473:pathology; D005269:Femur / Q000000981:diagnostic imaging / Q000473:pathology*; D005272:Femur Neck / Q000000981:diagnostic imaging; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D009929:Organ Size; D014057:Tomography, X-Ray Computed
keywords: Anatomy; Femur; Intra-operative fractures; Total Hip Arthroplasty