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Yan SG, Wang Z, Cui Y, Hua X, Liu F, Li D. Primary stability of multi-hole acetabular cup combined with posterior column plating for the fixation of complex acetabular fractures in elderly patients: a biomechanical analysis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05418-y. [PMID: 38926197 DOI: 10.1007/s00402-024-05418-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/22/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Acute total hip arthroplasty has gained increasing popularity in the treatment of complex acetabular fractures in elderly patients, but the biomechanical evidence is lacking. Therefore, we measured the primary stability to evaluate whether acute total hip arthroplasty using a multi-hole acetabular cup and posterior column plating through a single K-L approach can safely be used for treating complexed acetabular fractures in the elderly. METHODS In 18 composite osteoporotic hemipelves, T-type acetabular fractures were treated in three ways: CSP (Cup with acetabular screws augmentation combined with posterior plate) group, CP (Cup without acetabular screw combined with posterior plate) group and CSPA (Cup with acetabular screws combined with posterior plate and anterior plate) group. Each specimen was dynamically loaded (300 to 1700 N, 1 Hz). Primary stability of the acetabular cup and fracture gap was evaluated by 3-dimensional (3D) micromotions. RESULTS No significant differences in the 3D-micromotions were observed among the CSP, CP and CSPA groups except the test point on the anterior column of the acetabulum in the CP scenario (CSP 49.33 ± 21.08 μm vs. CP 224.83 ± 52.29 μm, p < 0.001; CSPA 45.50 ± 12.16 μm vs. CP 224.83 ± 52.29 μm, p < 0.001). No significant differences in the fracture gap displacement on the posterior column of acetabulum were observed among the CSP, CP and CSPA groups. CONCLUSION Our results show, that acute total hip arthroplasty using a multi-hole cup with acetabular screws and posterior column plating through single a K-L approach offers good primary stability to allow good osseous integration for treating complex acetabular fractures in the elderly. Furthermore, it also provides good fracture gap displacement on the posterior column.
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Affiliation(s)
- Shuang G Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Zhi Wang
- Department of Orthopaedic Surgery, Beijing Oriental Electronics Hospital, Hefei, China
| | - Yiliang Cui
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xingyi Hua
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital, Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Di Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Naval Medical University, Changhai Hospital, Shanghai, China.
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Gencarelli P, Menken LG, Hong IS, Robbins CJ, Jankowski JM, Yoon RS, Liporace FA. No Difference in Acute Outcomes for Patients Undergoing Fix and Replace Versus Fixation Alone in the Treatment of Geriatric Acetabular Fractures. J Orthop Trauma 2024; 38:88-95. [PMID: 38031287 DOI: 10.1097/bot.0000000000002733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To compare acute outcomes between patients undergoing fix and replace (FaR) versus open-reduction and internal fixation (ORIF) alone in the treatment of geriatric acetabular fractures. METHODS DESIGN Retrospective Cohort Study. SETTING Single Level 2 Trauma Center. PATIENT SELECTION CRITERIA Consecutive acetabular fracture patients ≥ 55 years of age treated by two orthopaedic trauma surgeons at one tertiary care center from January 2017 to April 2022 with FaR versus ORIF were identified. Included were those with complete datasets within the 180-day global period. Excluded were patients with previous ORIF of the acetabulum or femur, or revision total hip arthroplasty. OUTCOME MEASURES AND COMPARISONS The primary outcomes were length of hospital stay (LOS), postoperative weight-bearing status, postoperative disposition, time to postoperative mobilization, and 90-day readmission rates. Secondary outcomes compared included demographic information, injury mechanism, surgical time, complications, revisions, and preoperative and postoperative Hip Disability and Osteoarthritis Outcomes Score for Joint Replacement (HOOS Jr.) scores. These were compared between FaR and ORIF groups. RESULTS Seventeen FaR patients (average age 74.5 ± 9.0 years) and 11 ORIF patients (average age 69.4 ± 9.6 years) met inclusion criteria. Mean follow-up was 26.4 months (range: 6-75.6 months). More FaR group patients were ordered immediate weight-bearing as tolerated or partial weight-bearing compared with ORIF alone (70% vs. 9.0%, P = 0.03). More patients in the FaR group had pre-existing hip osteoarthritis compared with ORIF alone (71% vs. 27%, P = 0.05). Fracture classification ( P = 0.03) and Charlson Comorbidity Index ( P = 0.02) differed between the 2 groups. There were no other differences in demographics, LOS ( P = 0.99), postoperative disposition ( P = 0.54), time to postoperative mobilization ( P = 0.38), 90-day readmission rates ( P = 0.51), operative time ( P = 0.06), radiographic union ( P = 0.35), time to union ( P = 0.63), pre- ( P = 0.32) or postoperative HOOS Jr. scores ( P = 0.80), delta HOOS Jr. scores ( P = 0.28), or reoperation rates between groups ( P = 0.15). CONCLUSIONS FaR and ORIF seem to be sound treatment options in the management of geriatric acetabular fractures. Patients in the FaR group achieved immediate or partial weight-bearing earlier than the ORIF group; however, time to postoperative mobilization did not differ between the two groups. The remainder of acute postoperative outcomes (LOS, postoperative disposition, and 90-day readmission rates) did not differ between the two groups. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Pasquale Gencarelli
- Divison of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center, RWJBarnabas Health, Livingston, Jersey City, NJ
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Giustra F, Cacciola G, Pirato F, Bosco F, De Martino I, Sabatini L, Rovere G, Camarda L, Massè A. Indications, complications, and clinical outcomes of fixation and acute total hip arthroplasty for the treatment of acetabular fractures: A systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:47-57. [PMID: 37640795 PMCID: PMC10771595 DOI: 10.1007/s00590-023-03701-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Acetabular fracture fixation can be challenging, especially in the elderly. Open reduction and internal fixation (ORIF) alone may not allow for early weight bearing and is associated with a high rate of secondary osteoarthritis; therefore, a combined hip procedure (CHP) or ORIF with acute total hip arthroplasty, may be beneficial in this population. The objective of this study was to perform a systematic review of all reported cases of CHP. METHODS PubMed, Embase, Scopus, and Cochrane databases were searched for studies analyzing acetabular fractures in the elderly managed with a combined hip procedure (CHP). The research was performed following the PRISMA guidelines. The included studies' methodological quality was evaluated using the MINORS score. The present study was registered on PROSPERO. RESULTS Eleven clinical studies were included in the final analysis. The mean age was 74.4 (63.2-78) years. Low-energy trauma was the most common mechanism of injury (64%). The most prevalent fracture pattern was the anterior column and posterior hemitransverse (ACPHT) (30.6%). The Kocher-Langenbeck approach was preferred for ORIF of posterior fractures and hip arthroplasty. The ilioinguinal approach and modified Stoppa were generally used for anterior fractures. The overall complication rate was 12.2%, and hip dislocation was the most frequent cause of reoperation (4.4%). The average Harris Hip Score reported postoperatively was 81.6 points, which was considered "good." CONCLUSIONS CHP is a safe treatment for elderly acetabular fractures with an acceptable complication and reoperation rate that results in good clinical outcomes. LEVEL OF EVIDENCE Level of evidence IV.
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Affiliation(s)
- Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | - Giorgio Cacciola
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy
| | - Francesco Pirato
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy.
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy.
| | - Ivan De Martino
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy
| | - Luigi Sabatini
- Ortopedia Protesica e Robotica - Humanitas Gradenigo, Turin, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lawrence Camarda
- Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, Palermo, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy
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Zhang BF, Zhuang Y, Liu L, Xu K, Wang H, Wang B, Wen HQ, Xu P. Current indications for acute total hip arthroplasty in older patients with acetabular fracture: Evidence in 601 patients from 2002 to 2021. Front Surg 2023; 9:1063469. [PMID: 36684223 PMCID: PMC9853543 DOI: 10.3389/fsurg.2022.1063469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/13/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose Older patient population with acetabular fractures is increasing rapidly, requiring enhanced recovery. Acute total hip arthroplasty (THA) is a good option for these patients, and it is becoming increasing popular. However, acute THA has different indications in different studies. Therefore, a systematic review is needed to assess and comprehend the indications for acute THA in older patients. Methods A systematic literature review was conducted to identify a retrospective series or prospective studies in older patients (>60 years) with acetabular fractures. The search timeline was from database construction till December 2021; PubMed, Embase, and Cochrane Library databases were searched. Two trained professional reviewers independently read the full text of documents that met the inclusion criteria and extracted information on the specific methods used and indication information based on the research design. Results In total, there were 601 patients with acetabular fractures aged >60 years from 33 studies were obtained. Twenty-eight studies reported that THA was a feasible treatment option for acetabular fractures in geriatric patients with good outcome. The primary indications were dome impaction, irreducible articular comminution, femoral head injury, and pre-existing osteoarthritis or avascular necrosis. The most common patterns were anterior column and posterior hemitransverse, posterior wall, both columns, and T-type. Conclusion Acute THA is an effective treatment strategy for older patients with acetabular fractures and should be considered when the abovementioned indications are observed on preoperative images. (PROSPERO: CRD42022329555).
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Affiliation(s)
- Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Yan Zhuang
- Department of Orthopaedic Trauma, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Lin Liu
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Ke Xu
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Hu Wang
- Department of Orthopaedic Trauma, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Bo Wang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Hong-Quan Wen
- Department of Orthopaedic Trauma, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Peng Xu
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China,Correspondence: Peng Xu
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Ciolli G, Mesnard G, Deroche E, Gunst S, Batailler C, Servien E, Lustig S. Is Cemented Dual-Mobility Cup a Reliable Option in Primary and Revision Total Hip Arthroplasty: A Systematic Review. J Pers Med 2022; 13:jpm13010081. [PMID: 36675742 PMCID: PMC9867154 DOI: 10.3390/jpm13010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/22/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
Background: Instability is a common complication following total hip arthroplasty (THA). The dual mobility cup (DMC) allows a reduction in the dislocation rate. The goal of this systematic review was to clarify the different uses and outcomes according to the indications of the cemented DMC (C-DMC). Methods: A systematic review was performed using the keywords "Cemented Dual Mobility Cup" or "Cemented Tripolar Cup" without a publication year limit. Of the 465 studies identified, only 56 were eligible for the study. Results: The overall number of C-DMC was 3452 in 3426 patients. The mean follow-up was 45.9 months (range 12-98.4). In most of the cases (74.5%) C-DMC was used in a revision setting. In 57.5% DMC was cemented directly into the bone, in 39.6% into an acetabular reinforcement and in 3.2% into a pre-existing cup. The overall dislocation rate was 2.9%. The most frequent postoperative complications were periprosthetic infections (2%); aseptic loosening (1.1%) and mechanical failure (0.5%). The overall revision rate was 4.4%. The average survival rate of C-DMC at the last follow-up was 93.5%. Conclusions: C-DMC represents an effective treatment option to limit the risk of dislocations and complications for both primary and revision surgery. C-DMC has good clinical outcomes and a low complication rate.
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Affiliation(s)
- Gianluca Ciolli
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Sacred Heart Catholic University, 00168 Rome, Italy
| | - Guillaume Mesnard
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Correspondence:
| | - Etienne Deroche
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
| | - Stanislas Gunst
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Cécile Batailler
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Elvire Servien
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- LIBM—EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 69622 Lyon, France
| | - Sébastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
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Zanna L, Ceri L, Scalici G, Boncinelli D, Burchette DT, Buzzi R, De Biase P. Outcome of surgically treated acetabular fractures: risk factors for postoperative complications and for early conversion to total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03451-4. [PMID: 36495349 DOI: 10.1007/s00590-022-03451-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The gold standard of Acetabular fractures treatment is open reduction and internal fixation (ORIF). Our purpose is to assess the short- to medium-term outcomes and complications of surgically treated acetabular fractures. We analysed factors influencing clinical outcomes, incidence of complications and predictors of conversion in total hip arthroplasty (THA). MATERIALS AND METHODS We retrospectively analysed 102 patients with acetabular fracture surgically treated between December 2017 and September 2020. We evaluated the quality of reduction with x-ray measuring residual displacement, classified into 3 groups (Matta Radiological Score). At the final follow-up, radiographs were graded according to Matta's Radiological Outcome Grading, and the clinical outcomes were graded using Oxford Hip Score (OHS). RESULTS 62 patients were enrolled. OHS was influenced by quality of reduction (p = 0.031), injury severity score (ISS) (p = 0.003) and BMI > 30 (p < 0.0001). The late sequelae were heterotopic ossification (HO) in 13 patients, osteoarthritis (OA) in 22 and avascular necrosis (AVN) in 4. HO was significantly affected by posterior approach and ISS > 15. The analysis showed a correlation between AVN and posterior hip dislocation. OA had a correlation with postoperative quality of reduction (p = 0.014). Eight patients required THA with a significant correlation between THA and posterior dislocation, isolated posterior wall fracture and ISS > 15. CONCLUSION A high rate of patients with acetabular fractures still develop complications and require THA. Identification of predictors for poor outcome may help to inform surgical decision-making regarding options of plate osteosynthesis or 'Fix and Replace', to avoid poor outcomes and early revision surgery.
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Affiliation(s)
- Luigi Zanna
- Department of Traumatology and General Orthopaedics, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy.
| | - Lorenzo Ceri
- Department of Traumatology and General Orthopaedics, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Gianluca Scalici
- Department of Traumatology and General Orthopaedics, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Debora Boncinelli
- Department of Traumatology and General Orthopaedics, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
| | | | - Roberto Buzzi
- Department of Traumatology and General Orthopaedics, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Pietro De Biase
- Department of Traumatology and General Orthopaedics, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
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Chen MJ, Wadhwa H, Bellino MJ. Sequential ilioinguinal or anterior intrapelvic approach with anterior approach to the hip during combined internal fixation and total hip arthroplasty for acetabular fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:635-641. [PMID: 33099680 DOI: 10.1007/s00590-020-02810-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This study examined the complications and outcomes of geriatric acetabular fractures treated with open reduction internal fixation (ORIF) and total hip arthroplasty (THA) performed via combined ilioinguinal or anterior intrapelvic (AIP) approach to acetabulum and anterior approach to the hip. METHODS Eight patients with a fracture of the acetabulum were treated at a Level I trauma center between 2010 and 2019 with combined ORIF/THA using an ilioinguinal or AIP approach for the acetabulum and a separate anterior approach to the hip. Wound dehiscence, peri-incisional skin necrosis, surgical site infection, dislocation, fracture union, acetabular component stability, and heterotopic ossification (HO) were utilized as outcome measures. Merle d'Aubigné-Postel scores were collected for the six patients that had one-year minimum follow-up. RESULTS The mean patient age was 77 years. Four patients had anterior wall fractures, two had associated both column fractures, and two had anterior column-posterior hemitransverse fractures. All fractures healed with stable fixation of the acetabular component by 6 months. There were no instances of skin necrosis, dislocation, infection, or re-operation. One patient had a superficial wound dehiscence that resolved with local wound care. One patient developed radiographic HO but was clinically asymptomatic. The mean Merle d'Aubigné-Postel score was 15.8 (range = 14-16). CONCLUSIONS Our small series of geriatric patients with fracture of the acetabulum treated with combined ORIF/THA, via the ilioinguinal or AIP approach with a separate anterior approach to the hip, demonstrates satisfactory outcomes with low complications after one-year of follow-up. Further research of these challenging injuries with more patients is warranted in order to determine the subset of fracture types best treated with this method and THA survivorship.
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Affiliation(s)
- Michael J Chen
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, Stanford, CA, 94063-6342, USA.
| | - Harsh Wadhwa
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, Stanford, CA, 94063-6342, USA
| | - Michael J Bellino
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, Stanford, CA, 94063-6342, USA
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Total hip arthroplasty in acetabular fractures. J Clin Orthop Trauma 2020; 11:1090-1098. [PMID: 33192013 PMCID: PMC7656485 DOI: 10.1016/j.jcot.2020.10.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 01/22/2023] Open
Abstract
Total Hip Arthroplasty (THA) is a well-accepted treatment for established hip arthritis following acetabular fractures. If a conservatively managed or operated case progresses to non-union/mal-union failing to restore the joint integrity, it may eventually develop secondary arthritis warranting a total hip arthroplasty. Also, in recent years, acute total hip arthroplasty is gaining importance in conditions where the fracture presents with pre-existing hip arthritis, is not amenable to salvage by open reduction and internal fixation, or, a poor prognosis is anticipated following fixation. There are several surgical challenges in performing total hip arthroplasty for acetabular fractures whether acute or delayed. As a separate entity elderly patients pose a distinct challenge due to osteoporosis and need stable fixation for early weight bearing alleviating the risk of any thromboembolic event, pulmonary complications and decubitus ulcer. The aim of surgery is to restore the columns for acetabular component implantation rather than anatomic fixation. Meticulous preoperative planning with radiographs and Computed Tomography (CT) scans, adequate exposure to delineate the fracture pattern, and, availability of an array of all instruments and possible implants as backup are the key points for success. Previous implants if any should be removed only if they are in the way of cup implantation or infected. Press fit uncemented modern porous metal acetabular component with multiple screw options is the preferred implant for majority of cases. However, complex fractures may require major reconstruction with revision THA implants especially when a pelvic discontinuity is present.
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