Intraoperative complications during total hip arthroplasty: a very uncommon intraoperative femur fracture occurred in a malnourished osteoporotic patient.

Intraoperative complications during total hip arthroplasty: a very uncommon intraoperative femur fracture occurred in a malnourished osteoporotic patient.

Authors

Keywords:

intraoperative femur fracture, plating, malnutrition, osteoporosis, tha complications

Abstract

Intraoperative femoral fracture is a rare but growing complication of primary total hip arthroplasty. We aimed to present an uncommon related case, assessing also the role of malnutrition and osteoporosis. We discuss the case of a 49 years old male patient, malnourished and osteoporotic, with an intertrochanteric, multifragmentary, inveterate fracture, that happened three months before. During the prosthetic surgery, a supracondylar fracture occurred. We synthesized it with a 13 holes LISS plate, 7 distal screws and 3 proximal cerclage wires. The leg was immobilized to 0° for 3 weeks and the load forbidden for 3 months. Calcium, Albumine, Total Proteins, Osteocalcin and Vitamin-D levels were below the normal range. Teriparatide was administered for 6 months. Global investigation of the patient's nutritional status is recommended before joint replacement and preoperative planning is mandatory to choose the adequate implant. Osteoanabolic therapy could be advisable to favor fracture healing.



References

National Joint Registry for England. Wales, Northern Ireland and the Isle of Man. 13th Annual Report. 2016. http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/13th%20Annual%20Repor/07950%20NJR%20Annual%20Report%202016%20ONLINE%20REPORT.pdf

Maradit Kremers H, Larson DR, Crowson CS, et al. Prevalence of Total Hip and Knee Replacement in the United States. J Bone Joint Surg Am2015;359:1386-97.

Fortina M, Carta S, Gambera D, Crainz E, Ferrata P, Maniscalco P. Recovery of physical function and patient’s satisfaction after total hip replacement (THR) surgery supported by a tailored guide-book. Acta Biomed. 2005 Dec;76(3):152-6. PMID: 16676564.

Singh JA, Yu S, Chen L, Cleveland JD. Rates of Total Joint Replacement in the United States: Future Projections to 2020-2040 Using the National Inpatient Sample. J Rheumatol. 2019 Sep;46(9):1134-1140. doi: 10.3899/jrheum.170990. Epub 2019 Apr 15. PMID: 30988126.

Perticarini L, Rossi SMP, Fioruzzi A, Jannelli E, Mosconi M, Benazzo F. Modular tapered conical revision stem in hip revision surgery: mid- term results. BMC Musculoskelet Disord. 2021 Jan 6;22(1):29. doi: 10.1186/s12891-020-03886-y. PMID: 33407327; PMCID: PMC7786466.

Sloan M, Premkumar A, Sheth NP. Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am. 2018 Sep 5;100(17):1455-1460. doi: 10.2106/JBJS.17.01617. PMID: 30180053.

Varacallo M, Luo TD, Johanson NA. Total Hip Arthroplasty Techniques. 2021 Jul 25. In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29939641.

Davidson D, Pike J, Garbuz D, Duncan CP, Masri BA. Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am. 2008 Sep;90(9):2000-12. doi: 10.2106/JBJS.H.00331. PMID: 18762663.

Ferbert T, Jaber A, Gress N, Schmidmaier G, Gotterbarm T, Merle C. Impact of intraoperative femoral fractures in primary hip arthroplasty: a comparative study with a mid-term follow-up. Hip Int. 2020 Sep;30(5):544-551. doi: 10.1177/1120700019849911. Epub 2019 May 17. PMID: 31096789.

Zhao R, Cai H, Liu Y, Tian H, Zhang K, Liu Z. Risk Factors for Intraoperative Proximal Femoral Fracture During Primary Cementless THA. Orthopedics. 2017 Mar 1;40(2):e281-e287. doi: 10.3928/01477447-20161116-06. Epub 2016 Nov 23. PMID: 27874909.

Masri BA, Meek RM, Duncan CP. Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res. 2004 Mar;(420):80-95. doi: 10.1097/00003086-200403000-00012. PMID: 15057082.

Ponzio DY, Shahi A, Park AG, Purtill JJ. Intraoperative proximal femoral fracture in primary cementless total hip arthroplasty. J Arthroplast. 2015;30:1418–22. https://doi.org/10.1016/j.arth.2015.02.043.

Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B,

Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone. 1993 May-Jun;14(3):231-42. doi: 10.1016/8756-3282(93)90146-2. PMID: 8363862

Maniscalco P, Quattrini F, Ciatti C, et al. The Italian Covid-19 Phase 2 in Piacenza: results of the first semester of 2020 and future prospective of new orthopedics surgical procedures. Acta Biomed. 2020 Nov 10;91(4):e2020159. doi: 10.23750/abm.v91i4.10377. PMID: 33525208; PMCID: PMC7927514.

Maniscalco P, Ciatti C, Gattoni S, et al. The impact of COVID-19 pandemic on the Emergency Room and Orthopedic Departments in Piacenza: a retrospective analysis. Acta Biomed. 2020 Dec 30;91(14-S):e2020028. doi: 10.23750/abm.v91i14-S.11003. PMID: 33559619; PMCID: PMC7944696.

Muller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones; Springer, Berlin. 1990.

Abdel MP, Watts CD, Houdek MT, Lewallen DG,

Berry DJ. Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Joint J. 2016 Apr;98-B(4):461-7. doi: 10.1302/0301-620X.98B4.37201. Erratum in: Bone Joint J. 2020 Dec;102-B(12):1782. PMID: 27037427.

Castelli A, Rossi SMP, Rocca L, Jannelli E, Benazzo F. Treatment of Vancouver B1, C periprosthetic hip fractures with periprosthetic polyaxial locking plate system: A 3-year follow-up. J Biol Regul Homeost Agents. 2018 Nov-Dec;32(6 Suppl. 1):209-216. PMID: 30644304.

O’Toole RV, Gobezie R, Hwang R, et al. Low complication rate of LISS for femur fractures adjacent to stable hip or knee arthroplasty. Clin Orthop Relat Res. 2006 Sep;450:203-10. doi: 10.1097/01.blo.0000223987.59702.17. PMID: 16721350.

Siddiqi A, Springer BD, Chen AF, Piuzzi NS. Diagnosis and Management of Intraoperative Fractures in Primary Total Hip Arthroplasty. J Am Acad Orthop Surg. 2021 May 15;29(10):e497-e512. doi: 10.5435/JAAOS-D-20-00818. PMID: 33475301.

Scott T, Salvatore A, Woo P, Lee YY, Salvati EA, Gonzalez Della Valle A. Polished, Collarless, Tapered, Cemented Stems for Primary Hip Arthroplasty May Exhibit High Rate of Periprosthetic Fracture at Short-Term Follow-Up. J Arthroplasty. 2018 Apr;33(4):1120-1125. doi: 10.1016/j.arth.2017.11.003. Epub 2017 Nov 14. PMID: 29223405.

Russell LA. Osteoporosis and orthopedic surgery: effect of bone health on total joint arthroplasty outcome. Curr Rheumatol Rep. 2013 Nov;15(11):371. doi: 10.1007/s11926-013-0371-x. PMID: 24085661.

Karachalios TS, Koutalos AA, Komnos GA. Total hip arthroplasty in patients with osteoporosis. Hip Int. 2020 Jul;30(4):370-379. doi: 10.1177/1120700019883244. Epub 2019 Oct 31. PMID: 31672068.

Delsmann MM, Strahl A, Mühlenfeld M, et al. High prevalence and undertreatment of osteoporosis in elderly patients undergoing total hip arthroplasty. Osteoporos Int. 2021 Aug;32(8):1661-1668. doi: 10.1007/s00198-021-05881-y. Epub 2021 Feb 11. PMID: 33575911; PMCID: PMC8376703.

Tan Y, Jiang L, Liu H, Pan Z, Wang H, Chen L. The effect of preoperative hypoalbuminemia on complications after primary hip arthroplasty. J Orthop Surg Res. 2021 Sep 15;16(1):562. doi: 10.1186/s13018-021-02702-0. PMID: 34526075; PMCID: PMC8442294.

Newman JM, Sodhi N, Khlopas A, et al. Malnutrition increases the 30-day complication and re-operation rates in hip fracture patients treated with total hip arthroplasty. Hip Int. 2020 Sep;30(5):635-640. doi: 10.1177/1120700019862977. Epub 2019 Jul 15. PMID: 31304789.

He M, Fan Q, Zhu Y, et al. The need for nutritional assessment and interventions based on the prognostic nutritional index for patients with femoral fractures: a retrospective study. Perioper Med (Lond). 2021 Dec 20;10(1):61. doi: 10.1186/s13741-021-00232-1. PMID: 34930445; PMCID: PMC8686570.

Cheraghi Z, Doosti-Irani A, Almasi-Hashiani A, et al. The effect of alcohol on osteoporosis: A systematic review and meta-analysis. Drug Alcohol Depend. 2019 Apr 1;197:

-202. doi: 10.1016/j.drugalcdep.2019.01.025. Epub 2019 Feb 27. PMID: 30844616.

González-Reimers E, Quintero-Platt G, Rodríguez-Rodríguez E, Martínez-Riera A, Alvisa-Negrín J, Santolaria-Fernández F. Bone changes in alcoholic liver disease. World J Hepatol. 2015 May 28;7(9):1258-64. doi: 10.4254/wjh.v7.i9.1258. PMID: 26019741; PMCID: PMC4438500.

Ahlborg HG, Johnell O, Karlsson MK. An age-related medullary expansion can have implications for the long-term fixation of hip prostheses. Acta Orthop Scand. 2004 Apr;75(2):154-9. doi: 10.1080/00016470412331294405. PMID: 15180230.

Zhen P, Chang Y, Yue H, et al. Primary total hip arthroplasty using a short bone-conserving stem in young adult osteoporotic patients with Dorr type C femoral bone. J Orthop Surg Res. 2021 Jan 7;16(1):17. doi: 10.1186/s13018-020-01985-z. PMID: 33413495; PMCID: PMC7789779.

Mantelli P, Fioruzzi A, Bisogno L, Fioruzzi C, Fusco U, Olivieri M, Lisanti M. Short femoral stem and porous titanium: winning combination? Acta Biomed. 2014 Sep 26;85 Suppl 2:71-4. PMID: 25409722.

Kleerekoper M, Greenspan SL, Lewiecki EM, et al. Assessing the Effects of Teriparatide Treatment on Bone Mineral Density, Bone Microarchitecture, and Bone Strength. J Bone Joint Surg Am. 2014 Jun 4;96(11):e90. doi: 10.2106/JBJS.L.01757. Epub 2014 Jun 4. PMID: 24897747; PMCID: PMC6948798.

Huang TW, Chuang PY, Lin SJ, et al. Teriparatide Improves Fracture Healing and Early Functional Recovery in Treatment of Osteoporotic Intertrochanteric Fractures. Medicine (Baltimore). 2016 May;95(19):e3626. doi: 10.1097/MD.0000000000003626. PMID: 27175673; PMCID: PMC4902515.

Huang TW, Chuang PY, Lin SJ, et al. Teriparatide Improves Fracture Healing and Early Functional Recovery in Treatment of Osteoporotic Intertrochanteric Fractures. Medicine (Baltimore). 2016 May;95(19):e3626. doi: 10.1097/MD.0000000000003626. PMID: 27175673; PMCID: PMC4902515.

Mancilla EE, Brodsky JL, Mehta S, Pignolo RJ, Levine MA. Teriparatide as a systemic treatment for lower extremity nonunion fractures: a case series. Endocr Pract. 2015 Feb;21(2):136-42. doi: 10.4158/EP14315.OR. PMID: 25297667

Caliogna L, Medetti M, Bina V, et al. Pulsed Electromagnetic Fields in Bone Healing: Molecular Pathways and Clinical Applications. Int J Mol Sci. 2021 Jul 9;22(14):7403. doi: 10.3390/ijms22147403. PMID: 34299021; PMCID: PMC8303968.

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Published

23-06-2023

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1.
Intraoperative complications during total hip arthroplasty: a very uncommon intraoperative femur fracture occurred in a malnourished osteoporotic patient. Acta Biomed [Internet]. 2023 Jun. 23 [cited 2024 Jun. 22];94(S2):e2023171. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/13811