• Constant Foissey, Raymond Kenney, Francesco Luceri, Elvire Servien, Sébastien Lustig, and Cécile Batailler.
• Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Center of Excellence, Croix-Rousse Hospital, 103 Grande rue de la Croix-Rousse, Rhône-Alpes, 69004, Lyon, France. constant.foissey@chu-lyon.fr.
• Arch Orthop Trauma Surg. 2021 Apr 1; 141 (4): 675-681.

IntroductionGreater trochanter (GT) fractures affect 0.6-29% of patients after direct anterior approach (DAA) total hip arthroplasty (THA). Given the growing popularity of this approach, this study aimed to assess the evolution of the GT fractures during the learning curve, their risk factors and their consequences.Materials And Methods537 total hip arthroplasties were retrospectively included from May 2013 to December 2017 in a single academic centre. Patient characteristics, perioperative management, clinical consequences and postoperative radiographs were analysed.ResultsGT fractures represented 2.4% (n = 13) of the THA, and there was not a decrease with experience. The GT fracture patients did not require any additional support during the surgery, and full weight bearing was always allowed without any restriction. This complication only happened in females, with the risk significantly increased in those > 70 years old (OR = 4.9). There was no specific consequence during the follow-up, mean HHS score was 98.5 and all of the patients were satisfied or very satisfied postoperatively.ConclusionOlder osteoporotic women are known to be at risk for GT fracture during DAA THA. Those results reinforce the argument in favour of proper patient selection in DAA to lower the complications since it does not improve with surgeon's experience.Level Of EvidenceRetrospective, consecutive case series; Level IV.

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