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Greater trochanter fractures in the direct anterior approach: evolution during learning curve, risk factors and consequences

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Greater trochanter (GT) fractures affect 0.6–29% of patients after direct anterior approach (DAA) total hip arthroplasty (THA). Given the growing popularity of this approach, this study aimed to assess the evolution of the GT fractures during the learning curve, their risk factors and their consequences.

Materials and methods

537 total hip arthroplasties were retrospectively included from May 2013 to December 2017 in a single academic centre. Patient characteristics, perioperative management, clinical consequences and postoperative radiographs were analysed.

Results

GT fractures represented 2.4% (n = 13) of the THA, and there was not a decrease with experience. The GT fracture patients did not require any additional support during the surgery, and full weight bearing was always allowed without any restriction. This complication only happened in females, with the risk significantly increased in those > 70 years old (OR = 4.9). There was no specific consequence during the follow-up, mean HHS score was 98.5 and all of the patients were satisfied or very satisfied postoperatively.

Conclusion

Older osteoporotic women are known to be at risk for GT fracture during DAA THA. Those results reinforce the argument in favour of proper patient selection in DAA to lower the complications since it does not improve with surgeon’s experience.

Level of evidence

Retrospective, consecutive case series; Level IV.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Center of Excellence, Croix-Rousse Hospital, 103 Grande rue de la Croix-Rousse, Rhône-Alpes, 69004, Lyon, France

    Constant Foissey, Elvire Servien, Sébastien Lustig & Cécile Batailler

  2. Department of Orthopaedics, University of Rochester Medical Center, 4901 Lac De Ville Blvd Building D, Rochester, NY, 14618, USA

    Raymond Kenney

  3. Università Degli Studi Di Milano, Milan, Italy

    Francesco Luceri

  4. Interuniversity Laboratory of Human Movement Science-EA 7424, Université Lyon 1, Lyon, France

    Elvire Servien

  5. Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France

    Sébastien Lustig

Authors
  1. Constant Foissey
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  2. Raymond Kenney
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  3. Francesco Luceri
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  4. Elvire Servien
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  5. Sébastien Lustig
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  6. Cécile Batailler
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Contributions

CF: study design, data collection, statistical analysis, literature review and manuscript writing; RK: literature review and manuscript editing; FL: data collection and literature review; ES: study design and manuscript editing. SL: study design, supervision, literature review and manuscript editing; CB: study design and manuscript editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Constant Foissey.

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Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. CoFo, CB, FL and RK declare that they have no conflict of interest. SL: consultant for Stryker; institutional research support from Corin and Amplitude. ES: institutional research support from Corin.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Advisory Committee on Research Information Processing in the Field of Health (CCTIRS) approved this study on June 4, 2015 under number 15–430. For this type of study, formal consent is not required.

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Foissey, C., Kenney, R., Luceri, F. et al. Greater trochanter fractures in the direct anterior approach: evolution during learning curve, risk factors and consequences. Arch Orthop Trauma Surg 141, 675–681 (2021). https://doi.org/10.1007/s00402-020-03710-1

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  • DOI: https://doi.org/10.1007/s00402-020-03710-1

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