title: Risk Factors for Perioperative Femoral Fractures: Cementless Femoral Implants and the Direct Anterior Approach Using a Fracture Table.
abstract: With the increased popularity of the direct anterior approach, the issue of periprosthetic femur fractures has come into focus. The purpose of this article is to identify patient- and procedure-related characteristics that are associated with periprosthetic femur fractures in cementless total hip arthroplasties performed through a direct anterior approach using a fracture table.
  
  
  
  Five hundred primary total hip arthroplasties performed using cementless femoral implants through a direct anterior approach using a fracture table were evaluated for characteristics associated with perioperative prosthetic femur fracture within the first 3 months of surgery.
  
  
  
  Twenty-three hips (4.6%) incurred fractures, 13 (2.6%) intraoperative and 10 (2.0%) postoperative. Bivariate analyses demonstrated females and a body mass index (BMI) >40 with a higher risk of fractures overall and postoperative fractures. A significant difference in DORR ratios was seen in patients with intraoperative fractures and a significant difference seen with implant sizes in patients with postoperative fractures. Multivariable regression analyses demonstrated an increased risk of postoperative fracture with a BMI >40. As the DORR ratio and implant size increased, there was a reduced odds of intraoperative fracture.
  
  
  
  Concern for periprosthetic femur fractures using the direct anterior approach for total hip arthroplasty is high in female patients and in patients with morbid obesity (BMI >40), small DORR ratio, or small implant size.
authors.affiliation: Department of Orthopaedic Surgery, Palo Alto Medical Foundation, Palo Alto, CA.
authors.forename: James M
authors.initials: JM
authors.lastname: Hartford
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, CA.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Knowles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005269:Femur / Q000601:surgery*; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications; D009985:Orthopedics / Q000592:standards; D057068:Periprosthetic Fractures / Q000601:surgery*; D011183:Postoperative Complications; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: cementless implant; direct anterior approach; fracture table; periprosthetic fracture; primary hip arthroplasty