Intraoperative Proximal Femoral Fracture in Primary Cementless Total Hip Arthroplasty

Intraoperative proximal femoral fracture is a complication of primary cementless total hip arthroplasty (THA) at rates of 2.95-27.8%. A retrospective review of 2423 consecutive primary cementless THA cases identified 102 hips (96 patients) with fracture. Multivariate analysis compared fracture incidences between implants, Accolade (Stryker Orthopaedics) and Tri-Lock (DePuy Orthopaedics, Inc.), and evaluated potential risk factors using a randomized control group of 1150 cases without fracture. The fracture incidence was 4.4% (102/2423), 3.7% (36/1019) using Accolade and 4.9% using Tri-Lock (66/1404) (P = 0.18). Female gender (OR = 1.96; 95% CI 1.19-3.23; P = 0.008) and smaller stem size (OR = 1.64; 95% CI 1.04-2.63; P = 0.03) predicted increased odds of fracture. No revisions of the femoral component were required in the fracture cohort.