International Orthopaedics - 2026-03-03 - Journal Article
Do intraoperative calcar fractures increase early complications or revisions in short stem total hip arthroplasty? A propensity score matching study.
Suksathien Y, Suarjui J, Tippimanchai T, Asawasudsakorn S, Suksathien R, Chuvanichanon P
Topics
Key Takeaway
Intraoperative calcar fractures treated with double-loop cerclage wiring during short stem THA resulted in 0% revision rate at 2 years versus 2.03% in matched controls (p not significant), with no significant difference in subsidence, PFF, PJI, or dislocation.
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Summary
This study asked whether intraoperative calcar fractures (IOCF) during short stem THA increase 2-year complications and revision rates when treated with double-loop cerclage wiring. Using propensity score matching across 844 cases from 2010–2023, the IOCF group (n=80) showed no revisions versus 13 revisions (2.03%) in controls, with stem subsidence 1.25% vs. 1.72% and PFF 1.25% vs. 0.63%, none reaching statistical significance. Prompt intraoperative recognition and cerclage fixation appears to neutralize the expected adverse impact of calcar fracture on short-term implant stability.
Key Limitation
The 1:8 matching ratio and small IOCF group (n=80) provide insufficient statistical power to detect differences in individually rare complications, and 2-year follow-up does not capture late aseptic loosening or delayed subsidence that calcar compromise may precipitate.
Original Abstract
PURPOSE
Intraoperative calcar fracture (IOCF) can compromise initial stability, leading to stem subsidence and instability. We aimed to compare 2-year complications and revision rates between patients who sustained IOCF and matched controls without IOCF using short stem total hip arthroplasty (THA).
METHOD
Patients who underwent short stem THA from November 2010 to October 2023 were included. They were categorized into those who sustained IOCF and were treated intraoperatively with double-loops cerclage wiring, and those without IOCF. Propensity score matching was performed to balance baseline characteristics between the two groups. The following outcomes were evaluated at two years: femoral stem subsidence, periprosthetic femoral fracture (PFF), periprosthetic joint infection (PJI), dislocation, aseptic femoral loosening, and revision.
RESULTS
Initially, 844 cases were identified. After matching, 80 and 640 cases were included in IOCF and non-IOCF groups respectively. There was one case (1.25%) of stem subsidence in the IOCF group and 11 cases (1.72%) in the non-IOCF group, with no significant difference (p = 0.76). PFF occurred in one case (1.25%) of the IOCF group and four cases (0.63%) of the non-IOCF group; the difference was not significant (p = 0.53). In the non-IOCF group, there were five cases (0.78%) of PJI, 11 cases (1.72%) of dislocation, one case (0.16%) of aseptic femoral loosening and 13 cases (2%) of revisions. There was no revision in the IOCF group.
CONCLUSION
Short stem THA complicated by IOCF, when promptly recognized and treated intraoperatively, did not increase complications or revision rates at two years.