Elsevier

The Journal of Arthroplasty

Volume 17, Issue 6, September 2002, Pages 706-712
The Journal of Arthroplasty

Original Articles
Fractures of the greater trochanter induced by osteolysis with the anatomic medullary locking prosthesis*,**,*

https://doi.org/10.1054/arth.2002.33557Get rights and content

Abstract

Pathologic fractures of the greater trochanter associated with trochanteric osteolysis are a late complication of total hip arthroplasty that have been described only in case reports. In this study of 208 consecutive total hip arthroplasties with mean 12.2-year radiographic follow-up, we reviewed the incidence, presentation, treatment, and outcome of such fractures. A radiographic review revealed 9 hips (4.3%) with trochanteric fractures resulting from osteolysis, occurring at a mean follow-up of 129 months. Five were diagnosed at the time of their radiographic appearance. Four were treated without operative fixation, using crutches and limited weight bearing for 4 to 6 weeks. Seven fractures healed in situ without major displacement. One resulted in a nonunion of the tip of the greater trochanter, and the radiographic outcome of a recent fracture was unknown. We found that the risk of sustaining a fracture was independent of the size of the osteolytic lesion; however, the risk increased significantly when the lysis eroded the cortical bone of the greater trochanter. In our experience with the extensively porous-coated AML stem (DePuy, a Johnson & Johnson Company, Warsaw, IN), conservative treatment leads to reasonable radiographic and clinical results in cases with limited initial fracture displacement. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Material and methods

Between October 1982 and December 1984, 215 patients (108 men and 107 women) had 223 consecutive primary THAs at 1 center. All THAs involved the same components: a nonmodular cobalt-chrome Anatomic Medullary Locking (AML) Trispike cup (DePuy, a Johnson & Johnson Company, Warsaw, IN) with gamma-in-air–sterilized polyethylene inserts and a cobalt-chrome AML stem (DePuy, a Johnson & Johnson Company) featuring circumferential porous coating over at least 80% of its length with a nonmodular 32-mm

Clinical and radiographic presentation

Of 208 patients, 4.3% (9 patients [9 hips]) had a nontraumatic fracture of the greater trochanter resulting from trochanteric osteolysis. Of patients, 7 were men and 2 were women. At the time of the primary THA, the mean age of patients with fractures was 51.6 years (range, 25 to 72 years) compared with a mean age of 55.3 years (range, 16 to 84 years) in patients without fractures. There was no significant difference in age between the groups (P=.35, Mann-Whitney U test).

The patients with

Discussion

Femoral fractures after cementless or cemented THAs are a known complication [5]. However, nontraumatic fractures of the tip of the greater trochanter associated with osteolytic lesions in this location are discussed rarely in the long-term follow-up of THAs. The only available reviews are scattered case reports 1, 2.

The current long-term study of a consecutive series of THAs—performed at 1 center, using the cementless AML stem with its circumferential and extensively porous-coated

Summary

If a patient presents with a late onset of lateral hip pain with an AML stem, orthopaedists should consider a fracture of the greater trochanter. When a fracture has occurred at the tip of the greater trochanter associated with proximal femoral osteolysis, conservative treatment with crutches and limited weight bearing leads to reasonable clinical and radiographic results in cases with limited fracture displacement [5]. However, the fracture itself is an indicator for the presence of a

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*

No benefits or funds were received in support of this study.

**

Investigation performed at the Anderson Orthopaedic Research Institute, Alexandria, Virginia.

*

Reprint requests: Rebecca Wolf, Editor, Anderson Orthopaedic Research Institute, PO Box 7088, Alexandria, VA 22307. E-mail: [email protected]

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