Fractures of the Greater Trochanter Induced by Osteolysis with the Anatomic Medullary Locking Prosthesis.
Alexandra M. Claus, PhD, MD, Robert H. Hopper, Phd, Charles A. Engh, Sr., MD
Investigation performed at Anderson Orthopaedic Research Institute
Journal of Arthroplasty, September 2002 Volume 17 Number 6
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.