A 4-institution case series of 13 acetabular fractures occurring during cementless press-fit cup insertion in THA. It asks: what are the consequences of this complication, does timing of recognition change outcomes, and which patients are at risk? Underreaming of 1–3 mm was present in every case.
Press-fit underreaming of 1–2 mm became standard practice to improve initial cup stability and promote bone ingrowth — this paper was among the first clinical series to show the technique carries a real fracture risk in vivo, not just in cadaver models.
When you are inserting a cementless cup in an elderly woman, a patient with rheumatoid arthritis, or anyone with suspected osteoporosis, consider line-to-line reaming or a cemented socket upfront. The data are unambiguous: no fractures occurred with line-to-line reaming across four institutions.
If resistance during impaction feels abnormal, remove the cup and inspect the acetabulum directly. A missed intraoperative fracture dramatically worsens outcomes. 2 of 4 unrecognized fractures required revision, versus 0 of 9 when recognized and treated.
Remember that early postoperative radiographs can appear normal even when a fracture is present. If a patient has unexplained groin pain after THA with a difficult cup insertion, get follow-up imaging before dismissing the complaint.
A 4-institution case series of 13 acetabular fractures occurring during cementless press-fit cup insertion in THA. It asks: what are the consequences of this complication, does timing of recognition change outcomes, and which patients are at risk? Underreaming of 1–3 mm was present in every case.
Press-fit underreaming of 1–2 mm became standard practice to improve initial cup stability and promote bone ingrowth — this paper was among the first clinical series to show the technique carries a real fracture risk in vivo, not just in cadaver models.
When you are inserting a cementless cup in an elderly woman, a patient with rheumatoid arthritis, or anyone with suspected osteoporosis, consider line-to-line reaming or a cemented socket upfront. The data are unambiguous: no fractures occurred with line-to-line reaming across four institutions.
If resistance during impaction feels abnormal, remove the cup and inspect the acetabulum directly. A missed intraoperative fracture dramatically worsens outcomes. 2 of 4 unrecognized fractures required revision, versus 0 of 9 when recognized and treated.
Remember that early postoperative radiographs can appear normal even when a fracture is present. If a patient has unexplained groin pain after THA with a difficult cup insertion, get follow-up imaging before dismissing the complaint.