Greater trochanter chip fractures in the direct anterior approach for total hip arthroplasty

  • Yasuhiro Homma
  • Tomonori Baba
  • Hironori Ochi
  • Yu Ozaki
  • Hideo Kobayashi
  • Mikio Matsumoto
  • Takahito Yuasa
  • Kazuo Kaneko
Original Article • HIP - FRACTURES



The direct anterior approach (DAA) for the treatment of total hip arthroplasty (THA) has gained popularity in recent years. Chip fractures of the greater trochanter are frequently seen, but the risk factors for such fractures are unknown. The study aimed to identify the risk factors for chip fractures in patients undergoing primary THA by the DAA during the surgeons’ learning curve.

Materials and methods

From November 2011 to April 2015, the first experiences of three surgeons who performed 120 THAs by the DAA (120 hips; 40 cases per beginner surgeon) were included. The incidence of chip fracture of the greater trochanter, the size of the greater trochanter as measured by computed tomography, and the patients’ characteristics were retrospectively investigated.


After exclusion of 11 hips, the remaining 109 hips were investigated. Chip fracture of the greater trochanter was identified in 32 hips (29.4 %). Univariate analysis with and without fractures showed that the width and depth of the greater trochanter were statistically significant risk factors (p = 0.02 and p < 0.001, respectively). Multivariate analysis using a logistic regression model demonstrated that the depth of the greater trochanter was an independent risk factor for chip fracture of the greater trochanter (OR 1.725; 95 % CI 1.367–2.177; p < 0.001).


The size of the greater trochanter was identified as a risk factor for chip fracture of the greater trochanter. Novice surgeons should pay attention to the size of the greater trochanter when performing THA by the DAA.


Direct anterior approach Femoral fracture Greater trochanter Learning curve 


Authors’ contributions

TH, TB, and HK designed the study. YO, TY, MM, and HO obtained and analyzed the data. YH wrote the initial draft. KK and TY ensured the accuracy of the data and analysis.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical 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 study was approved by the medical research ethics committee at our university.

Informed consent

Informed consent was obtained from all individual patients in this study.


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Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  • Yasuhiro Homma
    • 1
  • Tomonori Baba
    • 1
  • Hironori Ochi
    • 1
  • Yu Ozaki
    • 1
  • Hideo Kobayashi
    • 1
  • Mikio Matsumoto
    • 1
  • Takahito Yuasa
    • 1
  • Kazuo Kaneko
    • 1
  1. 1.Department of Orthopaedic SurgeryJuntendo UniversityTokyoJapan

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