BACKGROUND
Surgical approach and body mass index (BMI) can influence early complications after cementless total hip arthroplasty (THA). This retrospective study aimed to compare Vancouver-type AG greater trochanteric periprosthetic fracture rates between anterolateral and posterolateral approaches in cementless THA and to examine whether higher BMI was more frequently observed among patients with these fractures.
MATERIAL AND METHODS
This single-center retrospective cohort study included 118 patients who underwent primary cementless THA between January 2019 and February 2023. Twenty-eight patients were treated using an anterolateral approach and 90 were treated with a posterolateral approach. Demographic data, BMI, Harris Hip Score (HHS), postoperative complications, acetabular inclination, and component migration were evaluated. Group comparisons, correlation analyses, and receiver operating characteristic (ROC) analysis were performed.
RESULTS
Vancouver-type AG fractures were more frequent after the anterolateral approach than after the posterolateral approach (25.0% vs 3.3%, P=0.02). Within the anterolateral group, patients with fractures had higher BMI, whereas no similar pattern was observed in the posterolateral group. Postoperative HHS was similar between approaches (85.86±12.33 vs 84.53±14.21, P=0.74). Acetabular vertical migration >2 mm was associated with lower postoperative HHS (P=0.01) and showed good discriminative ability for lower functional outcome (AUC=0.81, P=0.01).
CONCLUSIONS
In this cohort, Vancouver-type AG greater trochanteric periprosthetic fractures were more frequently observed after the anterolateral approach, and higher BMI was more common among patients with fractures, particularly within the anterolateral group. Early acetabular migration was associated with lower postoperative HHS scores and may help identify patients who require closer radiographic follow-up.

Keywords: Arthroplasty, Replacement, Hip; Body Mass Index; Hip Prosthesis; Obesity; Periprosthetic Fractures; Surgical Procedures, Operative; Orthopedics; Fractures, Bone; Retrospective Studies