Hip Pelvis.  2019 Mar;31(1):33-39. 10.5371/hp.2019.31.1.33.

Comparison of the Incidence of Intra-operative Fractures in Hip Hemi-arthroplasty Performed in Supine and Lateral Positions

• Kamo K
• Kido H
• Kido S

• KMID: 2448039
• DOI: http://doi.org/10.5371/hp.2019.31.1.33

Abstract

PURPOSE
The difficulty of femoral preparation with supine-position hip hemi-arthroplasty (HA) often leads to intra-operative fractures (IOFs). We aimed to clarify the incidence and types of IOFs in HA for hip fractures performed in the supine and lateral positions.
MATERIALS AND METHODS
We retrospectively investigated cases of HA for acute femoral neck fractures from June 2013 to May 2018. We examined the incidence and types of IOFs according to different approaches. We defined supine-position in HA as the supine and hip-hyperextended (over-range) femoral preparation position, and lateral position as the lateral and hip-flexed femoral preparation position. We used a short tapered wedged stem.
RESULTS
Supine-position HA was used in 46 patients (23.7%) and lateral-position HA in 148 patients (76.3%). IOFs in supine-position HA occurred in 8 patients (17.4%) and included five Vancouver AGT and three Vancouver B2 fractures. IOFs in lateral-position HA occurred in 3 patients (2.0%) and included one Vancouver AGT and two Vancouver B fractures. Supine-position HA was a risk factor for IOFs (adjusted odds ratio, 9.71; 95% confidence interval, 2.37-39.8; P < 0.01)
CONCLUSION
Supine-position in HA is an IOF risk factor and significantly increases the incidence of great trochanter fractures of Vancouver type A.

Keyword

Hip replacement arthroplasty; Periprosthetic fractures; Femoral neck fractures; Superior approach; Minimally invasive surgical procedures

MeSH Terms

Arthroplasty, Replacement, Hip
Femoral Neck Fractures
Femur
Hemiarthroplasty*
Hip Fractures
Hip*
Humans
Incidence*
Minimally Invasive Surgical Procedures
Odds Ratio
Periprosthetic Fractures
Retrospective Studies
Risk Factors

Figure

• 

  Fig. 1 (A) The trial outer head with groove to minimize difficulty in trial reduction. The flat broaches made the neck osteotomy possible leaving the broach in place. (B) Trial reduction on the left hip hemi-arthroplasty. The piriformis was retracted posteriorly and the gluteus medius was retracted anteriorly. (C) The piriformis (P) and the gluteus medius (Me) were preserved after implantation.

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