Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;31(7):1411-1419.
doi: 10.1007/s00590-021-02894-5. Epub 2021 Feb 13.

Periprosthetic occult acetabular fracture: an unknown side effect of press-fit techniques in primary cementless total hip arthroplasty

Ho Hyun Yun  1 , Seung Hee Cheon  2 , Jung Taek Im  2 , Yeong Yoon Koh  2
Affiliations

Periprosthetic occult acetabular fracture: an unknown side effect of press-fit techniques in primary cementless total hip arthroplasty

Ho Hyun Yun et al. Eur J Orthop Surg Traumatol. 2021 Oct.

Abstract

Background: This study sought to investigate the prevalence and risk factors of periprosthetic occult acetabular fracture occurring during cementless acetabular cup insertion in patients undergoing primary total hip arthroplasty (THA) and to assess the clinical consequences of these fractures.

Methods: A total of 232 hips (n = 205 patients) were included in this study. A periprosthetic occult acetabular fracture was defined as that which was unrecognised intraoperatively and was undetectable on post-operative radiographs yet was successfully diagnosed on post-operative computed tomography (CT) images. Clinical (age, sex, body mass index, and preoperative diagnosis) and surgical (additional screw fixation, cup rim size, and cup type) variables were analysed to identify risk factors for periprosthetic occult acetabular fracture.

Results: Sixteen (6.9%) periprosthetic occult intraoperative acetabular fractures were identified. In addition, one (0.4%) periprosthetic acetabular fracture was found during operation. The superolateral wall (9/16 hips; 56.3%) was the most frequent location. In addition, one (0.4%) periprosthetic acetabular fracture was found during operation. Male sex was the only factor associated with an increased risk for periprosthetic occult intraoperative acetabular fracture (odds ratio for male versus female sex: 4.28; p = 0.04). There was no significant association between cup type and the occurrence of periprosthetic occult acetabular fracture. All 16 hips with periprosthetic occult intraoperative acetabular fracture were healed at the final follow-up visit without the requirement for any additional surgical interventions.

Conclusion: The results of the current study suggest that periprosthetic occult acetabular fractures are common during press-fit acetabular cup insertion in primary THA. Surgeons should have a high index of suspicion and early CT imaging referral in male patients who present with unexplained early post-operative groin pain in primary THA using cementless acetabular cups.

Keywords: Acetabular fracture; Occult fracture; Periprosthetic fracture; Press-fit fixation; Total hip arthroplasty.

PubMed Disclaimer

References

    1. Davidson D, Pike J, Garbuz D, Duncan CP, Masri BA (2008) Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am 90:2000–2012 - DOI
    1. Yun HH, Lim JT, Yang SH, Park PS (2019) Occult periprosthetic femoral fractures occur frequently during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA. PLoS ONE 14:e0221731 - DOI
    1. Olory B, Havet E, Gabrion A, Vernois J, Mertl P (2004) Comparative in vitro assessment of the primary stability of cementless press-fit acetabular cups. Acta Orthop Belg 70(1):31–37 - PubMed
    1. Antoniades G, Smith EJ, Deakin AH, Wearing SC, Sarungi M (2013) Primary stability of two uncementedacetabular components of different geometry: hemispherical or peripherallyenhanced? Bone Joint Res 2(12):264–269 - DOI
    1. Abdel MP, Houdek MT, Watts CD, Lewallen DG, Berry DJ (2016) Epidemiology of periprosthetic femoral fractures in 5417 revision total hip arthroplasties: a 40-year experience. Bone Joint J 98:468–474 - DOI

MeSH terms

LinkOut - more resources