JAAOS - 2026-07-07 - Journal Article
Management of Intraoperative Fractures During Primary Direct Anterior Total Hip Arthroplasty.
Siddiqi A, DeJesus J, Yerasimides JG, Yousuf KM
Topics
Key Takeaway
Intraoperative fractures during DAA THA require approach-specific decision frameworks distinguishing stable constructs (observation or supplemental fixation) from unstable implants (revision techniques or extensile exposure), though no aggregate incidence rate is reported in this review.
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Summary
This narrative review addresses intraoperative acetabular and femoral fractures specific to DAA THA, cataloguing risk factors, injury mechanisms, and management algorithms. The authors stratify management by implant stability: stable constructs are managed with observation or supplemental fixation, while unstable implants require revision techniques, extensile exposure, or approach conversion. No pooled incidence data or outcome statistics are reported; the contribution is a structured decision-making framework rather than primary data.
Key Limitation
No primary outcome data, incidence figures, or comparative complication rates are reported, making it impossible to quantify fracture risk or validate the proposed management algorithm against clinical results.
Original Abstract
Direct anterior approach (DAA) total hip arthroplasty has seen increased adoption in the United States, although utilization varies globally with posterior approaches remaining prevalent in many regions. The muscle-sparing interval and potential for early functional recovery have contributed to its use; however, DAA introduces distinct technical challenges, particularly with femoral exposure and implant positioning. Intraoperative fractures, although relatively uncommon, represent a clinically important complication affecting both the acetabulum and the femur. Effective management requires early recognition, careful assessment of implant stability, and a structured, approach-specific decision-making strategy. Stable constructs may be managed with observation or supplemental fixation, whereas unstable implants often require revision techniques, extensile exposure, or alternative surgical approaches. This review outlines DAA-specific risk factors, mechanisms of injury, and evidence-based management strategies for intraoperative acetabular and femoral fractures, with emphasis on practical intraoperative decision making to restore stability and optimize outcomes.