Recognizing anterior metaphyseal femoral bone loss during uncemented total hip arthroplasty: the skylight sign

Orthopedics. 2007 Mar;30(3):218-21. doi: 10.3928/01477447-20070301-11.

Abstract

During preparation for uncemented femoral arthroplasty, a phenomenon has been observed that indicates thinning of anterior metaphyseal bone to a critical level. Light can be seen from within the canal passing through the anterior cortex. This skylight sign alerts the surgeon that a cortical defect or fracture can occur on reaming, broaching, or component insertion. In 420 consecutive arthroplasties, a skylight sign was noted in 97 (23%) hips. In 5 of those hips an oval cortical defect was created and in 3 hips a fracture occurred during broaching or insertion. Loosening developed in 1 hip with fracture. No fractures or defects occurred in hips without a skylight sign. If a skylight sign is present, the femur is at risk and preventive measures should be taken.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Bone Resorption / complications
  • Bone Resorption / diagnostic imaging
  • Bone Resorption / pathology*
  • Cementation
  • Female
  • Femoral Fractures / diagnostic imaging
  • Femoral Fractures / etiology
  • Femoral Fractures / pathology*
  • Femur / diagnostic imaging
  • Femur / injuries
  • Femur / pathology*
  • Humans
  • Intraoperative Complications / etiology
  • Intraoperative Complications / pathology*
  • Intraoperative Complications / prevention & control
  • Male
  • Middle Aged
  • Prospective Studies
  • Radiography
  • Reoperation