Abstract
Background
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.
Results
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).
Conclusion
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.
Similar content being viewed by others
References
Hueter C (1883) Funfte abtheilung: die verletzung undkrankheiten des hüftgelenkes, neunundzwanzigstes capitel. In: Hueter C (ed) Grundriss der chirurgie, 2nd edn. FCW Vogel, Leipzig, pp 129–200
Judet J, Judet H (1985) Voie d’abord antérieur dans l’arthroplastie totale de la hanche. La presse médicale 14:1031–1033
Baba T, Shitoto K, Kaneko K (2013) Bipolar hemiarthroplasty for femoral neck fracture using the direct anterior approach. World J Orthop 4(2):85
Matta JM, Shahrdar C, Ferguson T (2005) Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 441:115–124
Restrepo C, Parvizi J, Pour AE, Hozack WJ (2010) Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty 25(5):671–679
Seng BE, Berend KR, Ajluni AF, Lombardi AV (2009) Anterior-supine minimally invasive total hip arthroplasty: defining the learning curve. Orthop Clin North Am 40(3):343–350
Woolson ST, Pouliot MA, Huddleston JI (2009) Primary total hip arthroplasty using an anterior approach and a fracture table: short-term results from a community hospital. J Arthroplasty 24(7):999–1005
Homma Y, Baba T, Kobayashi H, Desroches A, Ozaki Y, Ochi H, Matsumoto M, Yuasa T, Kaneko K (2016) Safety in early experience with a direct anterior approach using fluoroscopic guidance with manual leg control for primary total hip arthroplasty: a consecutive one hundred and twenty case series. Int Orthop Mar. doi:10.1007/s00264-016-3159-6
Spaans AJ, van den Hout JA, Bolder SB (2012) High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop 83(4):342–346
Graves SC, Dropkin BM, Keeney BJ, Lurie JD, Tomek IM (2016) Does surgical approach affect patient-reported function after primary THA? Clin Orthop Relat Res 474(4):971–981
Moskal JT, Capps SG, Scanelli JA (2013) Anterior muscle sparing approach for total hip arthroplasty. World J Orthop 4(1):12
Jaret P (2013) A new approach to hip surgery. The New York Times; March 18, 2013. http://well.blogs.nytimes.com/2013/03/18/faster-recovery-from-hip-surgery/?_php=true&_type=blogs&_r=1
Zawadsky MW, Paulus MC, Murray PJ, Johansen MA (2014) Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplasty 29:1256
Oinuma K, Eingartner C, Saito Y, Shiratsuchi H (2007) Total hip arthroplasty by a minimally invasive, direct anterior approach. Oper Orthop Traumatol 19:310–326
Russo MW, Macdonell JR, Paulus MC, Keller JM, Zawadsky MW (2015) Increased complications in obese patients undergoing direct anterior total hip arthroplasty. J Arthroplasty 30(8):1384–1387
Christensen CP, Karthikeyan T, Jacobs CA (2014) Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty. J Arthroplasty 29(9):1839–1841
Barton C, Kim PR (2009) Complications of the direct anterior approach for total hip arthroplasty. Orthop Clin North Am 40(3):371–375
Asopa V, Al-Nammari S, Spriggins T, Menz T, Bauze A (2014) Sciatic nerve palsy following total hip replacement via direct anterior approach after recommencement of warfarin for prophylaxis in atrial fibrillation. Case Rep Orthop 2014:810481
Siguier T, Siguier M, Brumpt B (2004) Mini-incision anterior approach does not increase dislocation rate: a study of 1037 total hip replacements. Clin Orthop Relat Res 426:164–173
Nogler M, Krismer M, Hozack WJ, Merritt P, Rachbauer F, Mayr E (2006) A double offset broach handle for preparation of the femoral cavity in minimally invasive direct anterior total hip arthroplasty. J Arthroplasty 21:1206–1208
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Rights and permissions
About this article
Cite this article
Homma, Y., Baba, T., Ochi, H. et al. Greater trochanter chip fractures in the direct anterior approach for total hip arthroplasty. Eur J Orthop Surg Traumatol 26, 605–611 (2016). https://doi.org/10.1007/s00590-016-1798-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-016-1798-3