Anthropometric Computed Tomography Reconstruction Identifies Risk Factors for Cortical Perforation in Revision Total Hip Arthroplasty.

Background: The incidence of revision hip arthroplasty is increasing with nearly 100,000 annual procedures expected in the near future. Many surgeons use straight modular tapered stems in revisions; however, complications of periprosthetic fracture and cortical perforation occur, resulting in poor outcomes. Our objective was to identify patient demographics and femoral characteristics that predispose patients to cortical perforation when using the straight modular stems.

Methods: We used a computed tomography database and modeling software to identify patient demographics and morphologic femoral characteristics that predispose patients to cortical perforation during revision hip arthroplasty. Overall, 561 femurs from patients of various backgrounds were used, and statistical analysis was performed via the 2-sample t test.

Results: Decreased patient height (mean 163.0 vs 168.8 cm), radius of curvature (818 vs 939 mm), anterior-posterior (8.5 vs 13.8 mm) and medial-lateral (7.9 vs 11.3 mm) width of the isthmus, and distance of the isthmus from the greater trochanter (179 vs 186 mm) were all statistically significant risk factors for cortical perforation (P < .05).

Conclusion: This study identifies several patient-specific risk factors for cortical perforation during revision hip arthroplasty using straight modular tapered stems and highlights the importance of preoperative planning especially in patients with shorter stature, proximal location of the femoral isthmus, narrow femoral canal, and smaller radius of curvature. Also, when using a mid-length modular tapered stem without an extended trochanteric osteotomy, consideration should be given to using a kinked stem to avoid anterior cortical perforation.