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Link
http://www.orthosupersite.com/view.asp?rID=25279
'By Gina Brockenbrough'1st on the web (December 14, 2007)'December 2007'
'ORLANDO, Fla. — Although early periprosthetic femur fractures occurring after
total hip arthroplasty are considered rare, research now indicates an increase
in rates for some types of these fractures with current total hip arthroplasty
practices. '
'Daniel J. Berry, MD, and colleagues performed a database review of 7,612 primary
total hip arthroplasties (THAs) performed during a 10-year period and identified
periprosthetic femur fractures that occurred within 3 months after THA performed
using uncemented proximally coated stems.'
'Berry presented the results hereat the 24th Annual Current Concepts in Joint
Replacement Winter 2007 Meeting.'
'The investigators found 28 Vancouver Type A1 fractures that had occurred an
average of 27 days postop, 11 of which were not associated with any episode of
trauma. Of the 28 patients who sustained an early postoperative fracture, 19
were using arm support to ambulate at the time of the fracture.
''In addition, the investigators discovered a 0.14% incidence of these fractures
between 1987 and 2003. However, the incidence increased to 0.78% between 2004
and 2007 — a period that is associated with changes in orthopedic practices,
such as earlier mobilization, smaller incisions and the use of proximally-coated
stems.'
'"It occurs with increased incidence right now, and I think that it is fair to
say that it is becoming a little bit of a mini epidemic," Berry said.'
'The investigators hypothesized that the breaks could occur from unintegrated
stems placed under high loads, or may be unrecognized intraoperative fractures.
Berry suggested that surgeons can avoid these fractures by careful patient
selection, identifying fractures intraoperatively and recommending prophylactic
cerclage for specific patients.'
'"I think there may be a role for us to take a step back from our enthusiasm to
mobilize patients very rapidly and realize that, although we want to mobilize
them rapidly, we could also use a little caution in those first few weeks after
surgery to try to get the best long-term result without a catastrophic early
complication," he said.'
'For more information:'
'Berry, DJ. Immediate femoral fracture after primary THA: A mini-epidemic. #15.
Presented at the 24th Annual Current Concepts in Joint Replacement Winter 2007
Meeting. Dec. 12-17, 2007. Orlando, Fla.''
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