Original ArticlesFractures of the greater trochanter induced by osteolysis with the anatomic medullary locking prosthesis*,**,*
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
References (6)
- et al.
Fractures through cystic lesions of the greater trochanter: a cause of late pain after cementless total hip arthroplasty
J Arthroplasty
(1996) - et al.
Fractured femoral shaft through an osteolytic lesion resulting from the reaction to a prosthesis: a case report
J Bone Joint Surg Br
(1984) - et al.
“Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening
Clin Orthop
(1979)
Cited by (0)
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No benefits or funds were received in support of this study.
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Investigation performed at the Anderson Orthopaedic Research Institute, Alexandria, Virginia.
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Reprint requests: Rebecca Wolf, Editor, Anderson Orthopaedic Research Institute, PO Box 7088, Alexandria, VA 22307. E-mail: [email protected]