Intraoperative Fractures of Acetabulum and Proximal Femur in Cementless Primary Total Hip Arthroplasty: A Systematic Review

Introduction: Cementless Total Hip Arthroplasty (THA) is generally safe, but intraoperative fractures of the acetabulum and proximal femur can occur and can have significant consequences for the patient. This systematic review aims to synthesize the available literature on intraoperative fractures of the acetabulum and proximal femur during primary uncemented THA and highlight the incidence, risk factors, and potential preventive measures for these fractures, to improve patient outcomes and reduce the incidence of this complication. Methods: We conducted a thorough review in the PUBMED, EMBASE, Cochrane database and Scopus library, and extracted the articles describing the intraoperative acetabulum and femur fractures in primary cementless THA. Results: The initial search carried out produced 1792 results. After exclusion processing, 22 articles were included for the review. Of these, 16 were intraoperative fractures of the femur and 6 were intraoperative fractures of the acetabulum. Incidence of acetabular fractures was 0.49% and 2.7% for femoral fractures with female preponderance in both groups. Time of occurrence and location of the intra-operative fractures can vary widely, with femoral fractures occurring more commonly during broaching and acetabular fractures during cup implantation. Conclusion: A plethora of management options have been utilized according to surgeon preference and the fracture pattern as well as location. Standard principles of fracture fixation and arthroplasty should be followed to achieve stable internal fixation and any unstable fracture site should be bypassed with the utilization of long-stemmed components.