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Kirkeboe RL, Nordsletten L, Madsen JE, Dybvik E, Lie SA, Hallan G, Clarke-Jenssen J. Long-term follow-up and survival of delayed total hip arthroplasty following acetabular fracture: a matched cohort study of 552 cases from the Norwegian Arthroplasty Register. Hip Int 2024; 34:396-401. [PMID: 37990005 PMCID: PMC11071598 DOI: 10.1177/11207000231212884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/09/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Operative treatment of acetabular fractures generally yields good results, but several authors report up to 15-20% of patients developing post-traumatic osteoarthritis (OA). Previous studies have shown that total hip arthroplasty (THA) following post-traumatic OA have inferior results compared to THA for primary OA. The aim of this study was to report on long-term outcome of THA following acetabular fracture, compared to primary OA. MATERIALS AND METHODS We performed a matched cohort study with data from the Norwegian Arthroplasty Register (NAR). All patients receiving THA following an acetabular fracture between 1987 and 2018 were identified. A 3:1 matched cohort consisting of patients treated for primary OA with THA was selected using propensity scores and matched for age, gender and year of surgery. Survival analysis was performed with revision of any cause as endpoint. Cox regression was used to identify factors associated with risk of revision surgery. RESULTS 552 cases were identified, 397 men and 155 women. Mean age was 58.8 (11-91) years. 224 had previously been operated for the acetabular fracture, 328 had been treated non-operatively. Mean follow up time was 8.7 (1-29) years. Implant survival at 10 years was 79.7% (75.6-83.3) and at 20 years 62.4% (55.5-69.3). The hazard ratio for revision was 1.38 (1.07-1.77, p < 0.001) compared to the OA cohort, regardless of operative or non-operative treatment of the index acetabular fracture. Uncemented acetabular components had an increased risk of revision with hazard ratio for revision 1.61 (p = 0.012). CONCLUSIONS THA following an acetabular fracture can be performed with acceptable results regarding implant survival, however, we report an increased risk for revision when compared to primary OA. Our results indicate that previous operative fracture treatment does not increase the risk for THA revision compared to cases treated non-operatively.
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Affiliation(s)
- Ragnhild Loven Kirkeboe
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jan Erik Madsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eva Dybvik
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Hordaland, Norway
| | - Stein Atle Lie
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Hordaland, Norway
- Department of Clinical Dentistry, University of Bergen, Norway
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Hordaland, Norway
- Department of Clinical Medicine, University of Bergen, Norway
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Alqazzaz A, Bush AN, Zhuang T, Dehghani B, Gibon E, Nelson CL. Acute Total Hip Arthroplasty Following Acetabular Fracture is Associated With a High Risk of Revision, Dislocation, and Periprosthetic Fracture. J Arthroplasty 2024:S0883-5403(24)00369-3. [PMID: 38663688 DOI: 10.1016/j.arth.2024.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND The aim of this study was to compare outcomes between acute, subacute, and delayed arthroplasty for acetabular fractures occurring within 1 week, from 1 week to 6 months, or more than 6 months before the index total hip arthroplasty (THA), versus THA without a history of acetabular fracture as a control. METHODS We analyzed the records of patients undergoing primary THA who were enrolled in a national database for at least 2 years before and after the index procedure. Patients who had an initial diagnostic code for acetabular fracture occurring less than 1 week, from 1 week to 6 months, or at least more than 6 months before the THA were classified as acute THA (aTHA), subacute THA (saTHA), or delayed THA (dTHA), respectively. The control group was patients undergoing THA who did not have a history of acetabular fracture. There were 430,349 control primary THAs, 462 aTHAs, 675 saTHAs, and 1,162 dTHAs. RESULTS After adjusting for age, sex, region, and comorbidities, patients who had an aTHA and saTHA experienced statistically significant increased odds of revision, dislocation, and periprosthetic fracture compared to primary THA without a history of acetabular fracture. Similarly, dTHA was associated with increased odds of revision, dislocation, and periprosthetic fractures compared to primary THA. In the multivariate analysis, aTHA had statistically significant higher rates of dislocation when compared to dTHA. CONCLUSIONS Patients who had a history of acetabular fractures undergoing aTHA, saTHA, or dTHA have significantly increased rates of revision, periprosthetic fracture, and dislocation compared to primary THA in those who did not have a history of acetabular fractures.
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Affiliation(s)
- Aymen Alqazzaz
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ashleigh N Bush
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Thompson Zhuang
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Bijan Dehghani
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Emannuel Gibon
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Charles L Nelson
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Shaker F, Esmaeili S, Nakhjiri MT, Azarboo A, Shafiei SH. The outcome of conversion total hip arthroplasty following acetabular fractures: a systematic review and meta-analysis of comparative studies. J Orthop Surg Res 2024; 19:83. [PMID: 38245744 PMCID: PMC10799400 DOI: 10.1186/s13018-024-04561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/14/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Conversion total hip arthroplasty (THA) is considered the main treatment plan for patients with first-line treatment failure of acetabulum fracture. This meta-analysis aims to assess the effect of the type of initial treatment and timing of surgery on the outcomes of conversion THA. METHODS Using PRISMA guidelines, MEDLINE/PubMed, Scopus, Web of Science, and CENTRAL Cochrane were searched for articles published before October 14, 2022. Comparative studies investigating the outcome of THA following treatment failure of acetabular fracture were included. These articles were categorized into three groups, and the outcomes of treatment plans in each group were compared: (A) primary THA vs. conversion THA, (B) THA following conservative treatment vs. THA following ORIF, and (C) acute THA vs. delayed THA following prior treatment failure. Review Manager (RevMan, version 5.3) software was utilized to perform the statistical analysis. RESULTS Twenty-four comparative studies met the inclusion criteria (reported the data of 13,373 patients). Concerning group (A), the following complications were significantly higher in conversion THA: Infection (OR [95% CI] 3.19 [2.12, 4.79]; p value < 0.00001), dislocation (OR [95% CI] 4.58 [1.56, 13.45]; p value = 0.006), heterotopic ossification (OR [95% CI] 5.68 [3.46, 9.32]; p value < 0.00001), and Revision (OR [95% CI] 2.57 [1.65, 4.01]; p value < 0.00001). Postoperative HHS (SMD [95% CI] - 0.66 [- 1.24, - 0.08]; p value = 0.03) was significantly lower and operation time (SMD [95% CI] 0.88 [0.61, 1.15]; p value < 0.00001), blood loss (SMD [95% CI] 0.83 [0.56, 1.11]; p value < 0.00001), and bone graft need (OR [95% CI] 27.84 [11.80, 65.65]; p value < 0.00001) were significantly higher in conversion THA. Regarding group (B), bone graft need (OR [95% CI] 0.48 [0.27, 0.86]; p value = 0.01) was considerably higher in patients with prior acetabular fracture conservative treatment, while other outcomes were comparable. Respecting group (C), there were no significant differences in analyzed outcomes. However, systematically reviewing existing literature suggested a higher incidence rate of DVT following acute THA. CONCLUSION There were significantly higher postoperative complications and lower functional outcomes in conversion THA compared to primary THA. While complications and functional outcomes were comparable between ORIF and the conservative groups, the bone graft need was significantly higher in the conservative group. There were no significant differences between aTHA and dTHA. These results can assist surgeons in designing treatment plans based on each patient's clinical situation. Prospero registration code: CRD42022385508. LEVEL OF EVIDENCE III/IV.
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Affiliation(s)
- Farhad Shaker
- Orthopaedic Department, Orthopaedic Subspecialty Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Esmaeili
- Orthopaedic Department, Orthopaedic Subspecialty Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mobina Taghva Nakhjiri
- Orthopaedic Department, Orthopaedic Subspecialty Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Azarboo
- Orthopaedic Department, Orthopaedic Subspecialty Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Hossein Shafiei
- Orthopaedic Department, Orthopaedic Subspecialty Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Schmidutz F, Schreiner AJ, Ahrend MD, Stöckle U, Maier S, Histing T, Hemmann P. Risk of Periprosthetic Joint Infection after Posttraumatic Hip Arthroplasty following Acetabular Fractures. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:671-677. [PMID: 35605966 DOI: 10.1055/a-1810-7379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Raised complication rates have been reported for total hip arthroplasty (THA) in posttraumatic hip joints after acetabular fractures with prior open reduction and internal fixation (ORIF). The present study evaluated (I) postoperative surgical site infection and the risk of early infection following THA in posttraumatic hip joints after acetabular fractures and (II) the discriminatory ability of preoperative C-reactive protein (CRP) blood levels for periprosthetic joint infection (PJI). MATERIALS AND METHODS Patients were included who had undergone THA (2014-2019) after prior ORIF, and nonsurgically treated acetabular fractures. Patients' demographics and the duration between fracture and THA implantation were assessed. Preoperative diagnostic testing (laboratory results, hip aspirations) as well as the results of intraoperative microbiological swabs and sonication were also evaluated. Postoperative complications were recorded. RESULTS Sixty-seven patients (51 men/16 women) were included, with a mean age of 54.7 ± 14.0 years (range: 18.0-82.9). The mean time between acetabular fracture and THA was 13.5 ± 14.9 years (0.2-53.5). Four subgroups were classified: subgroup I (nonsurgical, n = 15), subgroup II (complete removal of osteosynthesis, n = 8), subgroup III (partial removal of osteosynthesis, n = 15), and subgroup IV (remaining osteosynthesis, n = 29). Preoperative CRP blood levels were normal. CRP levels had no discriminatory ability to predict PJI (AUC: 0.43). Positive microbiological swabs were assessed in subgroups III (n = 1) and IV (n = 2). Complications during follow-up occurred in subgroups I (one aseptic loosening [6.7%]), III (one wound revision [6.7%], two low-grade infections [13.3%]), and IV (three low-grade infections [10.3%]). CONCLUSION High infection rates were found in patients with THA after acetabular fracture with remaining implants or partial implant removal. Serum CRP alone seems to be a poor predictor. Therefore, an extensive diagnostic algorithm can help to detect an occult infection, including preoperative hip aspiration (microbiological samples and measurements of synovial CRP, WBC, and alpha-defensin levels). Intraoperative tissue samples and sonication results should be obtained during THA implantation.
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Affiliation(s)
- Florian Schmidutz
- Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen, Germany
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians-Universität München, München, Germany
| | - Anna Janine Schreiner
- Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen, Germany
| | - Marc-Daniel Ahrend
- Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen, Germany
| | - Ulrich Stöckle
- Center for Musculoskeletal Surgery (CMSC), Charite University Hospital Berlin, Berlin, Germany
| | - Sven Maier
- Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen, Germany
| | - Tina Histing
- Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen, Germany
| | - Philipp Hemmann
- Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen, Germany
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Ebrahimi HDN, Wu CH, Karczewski D, Amini DA, Dahne M, Bäcker HC. Total hip arthroplasty in acute acetabulum fractures: a systematic review. Arch Orthop Trauma Surg 2023; 143:6665-6673. [PMID: 37543998 DOI: 10.1007/s00402-023-05007-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The incidence of acetabular fractures has increased significantly in recent years due to demographic change. It can be divided into high-energy acetabular fractures primarily seen in adult patients versus geriatric patients mostly suffering from low-energy trauma. Historically, acetabular fractures have been treated either non-operatively or surgically following open reduction and internal fixation (ORIF), whereas nowadays total hip arthroplasty (THA) provides a true alternative. Aim of this study was to perform a systematic review on the outcome following THA in acute acetabulum fractures. METHODS PubMed/MEDLINE, Cochrane and Google databases were systematically searched on December 9, 2021. The key terms were [acetabular fracture] AND [[arthroplasty] OR [fixation]]. All retrospective and prospective original studies in English and German were analyzed the outcome following THA in acute acetabulum fractures were included. RESULTS A total of 2459 studies were screened, which includes 15 studies that met the inclusion criteria with a total of 590 patients at a mean age of 61.3 years (SD 11.48). Most studies described good to excellent results. Especially, THA allows elderly patients quicker mobilization and rehabilitation as well as symptomatic relief, as compared to ORIF or non-operative treatment. Patients who underwent non-operative treatment showed better results compared to those who underwent ORIF initially. CONCLUSION In acetabulum fractures, THA provides a good alternative with very good results when patients are carefully selected. Good to excellent outcomes are reported for both acute and delayed use of THA in elderly patients. LEVEL OF EVIDENCE Level 2, systematic review.
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Affiliation(s)
- Hadis Darvishi Nakhl Ebrahimi
- Center for Muskuloskeletal Surgery, Charité Berlin, UniversityHospital Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Chia H Wu
- Department of Orthopaedics and Sports Medicine, Baylor College of Medicine Medical Centre, Houston, TX, USA
| | - Daniel Karczewski
- Center for Muskuloskeletal Surgery, Charité Berlin, UniversityHospital Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Dominik Adl Amini
- Center for Muskuloskeletal Surgery, Charité Berlin, UniversityHospital Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Michael Dahne
- Center for Muskuloskeletal Surgery, Charité Berlin, UniversityHospital Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Henrik C Bäcker
- Center for Muskuloskeletal Surgery, Charité Berlin, UniversityHospital Berlin, Chariteplatz 1, 10117, Berlin, Germany.
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan, Parkville, VIC, 3052, Australia.
- Department of Orthopaedic Surgery, Auckland City Hospital, 1023, Auckland, New Zealand.
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6
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[Primary joint replacement for the treatment of acetabular fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:119-124. [PMID: 36534363 DOI: 10.1007/s00113-022-01266-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/23/2022]
Abstract
Open reduction and internal fixation are the gold standard for the treatment of dislocated acetabular fractures. A primary joint replacement is only justified in isolated cases. The indications are merely non-reconstructable acetabular fractures, accompanying displaced fractures of the femoral neck and non-reconstructable fractures of the femoral head.Because of the difficulties in achieving sufficient cup stability, joint replacement for the treatment of acetabular fractures regularly requires implants designed for revision arthroplasty. The Kocher-Langenbeck approach provides the most versatile options, as it enables simultaneous stabilization of the dorsal acetabular structures, which are essential for the stability of the cup.For primary joint replacement as a treatment of acetabular fractures, survival of the prosthetic cup is markedly worse when compared to elective primary joint replacement. Particularly in younger patients but also in aged patients, every effort should be made to achieve a press fit of the cup. In most cases, this will include reduction and fixation of the fracture for stabilization of the acetabulum prior to joint replacement. A staged approach with an early secondary replacement intervention seems to provide better overall results than simultaneous fracture fixation and joint replacement.
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O’Driscoll CS, Davey MS, Hughes AJ, O’Byrne JM, Leonard M, O’Daly BJ. Total Hip Arthroplasty in the Setting of Post-Traumatic Arthritis Following Acetabular Fracture: A Systematic Review. Arthroplast Today 2023; 19:101078. [PMID: 36691464 PMCID: PMC9860422 DOI: 10.1016/j.artd.2022.101078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/31/2022] [Accepted: 11/30/2022] [Indexed: 01/17/2023] Open
Abstract
Background Acetabular fractures are frequently associated with post-traumatic arthritis (PTA), for which total hip arthroplasty (THA) has emerged as the established procedure. The purpose of this systematic review is to report the patient outcomes, complications, and implant survival of delayed THA for patients with PTA following acetabular fracture. Methods A systematic review was performed in December 2021 as per Preferred Reporting Items for Systematic Review and Meta-Analysis Guidelines to identify all studies reporting outcomes of delayed THA performed for PTA with a history of acetabular fracture. From an initial screen of 893 studies, 29 studies which met defined inclusion criteria including minimum 12 months of follow-up and minimum 10 THA were included in the final review. Results A total of 1220 THA were reported across 29 studies, with 1174 THA completing a minimum of 1-year follow-up at a mean of 86 months. All 29 studies reported upon complications, with a control included in 6 for comparison. Higher complication rates were observed both in patients who had prior open reduction internal fixation and conservative treatment, most notably infection which was observed following 3.6% THA. The total joint revision rate was 9.7%. An improvement was noted in all 25 studies which recorded patient-reported outcomes, with a mean rise in the Harris hip score from 45 to 86 across 18 studies. Conclusions THA may reduce reported pain levels and improve functional outcomes in selected patients experiencing PTA following acetabular fractures. There is an increased risk of complications, necessitating careful consideration when planning the operation and open discussion with prospective patients and caregivers.
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Affiliation(s)
- Conor S. O’Driscoll
- Irish National Pelvic and Acetabular Centre, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, Galway University Hospital, Galway, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,Corresponding author. Royal College of Surgeons of Ireland, 123 St. Stephens Green, Dublin 2, Ireland. Tel.: +353857884714.
| | - Martin S. Davey
- Department of Trauma & Orthopaedics, Galway University Hospital, Galway, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Andrew J. Hughes
- Irish National Pelvic and Acetabular Centre, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,Rothman Orthopedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - John M. O’Byrne
- Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,Irish National Orthopaedic Hospital, Cappagh, Dublin, Ireland
| | - Michael Leonard
- Irish National Pelvic and Acetabular Centre, Tallaght University Hospital, Dublin, Ireland
| | - Brendan J. O’Daly
- Irish National Pelvic and Acetabular Centre, Tallaght University Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
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Gracia G, Laumonerie P, Tibbo ME, Cavaignac E, Chiron P, Reina N. Outcomes of acute versus delayed total hip arthroplasty following acetabular fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:51-60. [PMID: 34714391 DOI: 10.1007/s00590-021-03157-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/21/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Post-traumatic arthritis is known complication following acetabular fracture. The aim was to compare mid- to long-term outcomes of acute THA (aTHA) for acetabular fracture and delayed THA (dTHA) following failure of ORIF or conservative management. METHODS We retrospectively analysed 60 THA (21 aTHA; 39 dTHA) performed for acetabular fracture between 2004 and 2014 in 60 patients with a mean age of 59 years (20-94). Functional and Radiographic outcomes were assessed at a mean follow-up of 5 years (2-13) utilizing Oxford, Harris Hip (HHS), and Postel Merle d'Aubigné (PMA) scores and Brooker classification. RESULTS The mean HHS (73), Oxford (32) and PMA (12) scores were significantly lower in the aTHA group. Acute THA was significantly associated with lower postoperative Oxford (β = -4.2), HHS (β = -7.8), and PMA (β = -2.2) scores at mean 5 years (2-13). Eleven patients returned to the operating room. There were no significant differences between THA performed in acute or delayed fashion. The two primary reasons for revision were periprosthetic joint infection (n = 5) and aseptic loosening (n = 4). Survivorship free from reoperation at 10 years was 91% and 82% for aTHA and dTHA, respectively (p = 0.24). Increased PMA scores were associated with decreased overall survival of the THA free from reoperation (HR = 0.60). The degree of heterotopic ossification was significantly higher in the aTHA group (p < 0.001). CONCLUSION Acute THA in the setting of acetabular fracture is a technically challenging procedure. However, in the present series, aTHA provided satisfactory immediate stability and good survivorship at 10 years in a medically vulnerable patient population. LEVEL OF EVIDENCE Level 3; Therapeutic study.
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Affiliation(s)
- G Gracia
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France.
- Department of Orthopaedic Surgery, Polyclinique Côte Basque Sud, 7 Rue Leonce Goyetche, 64500, Saint-Jean-de-Luz, France.
| | - P Laumonerie
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - M E Tibbo
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - E Cavaignac
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - P Chiron
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - N Reina
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
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Glowalla C, Hungerer S, Stuby FM. [Techniques and results of primary hip arthroplasty in geriatric acetabular fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:924-935. [PMID: 36394608 DOI: 10.1007/s00113-022-01253-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
As a result of demographic changes, there is an increase in geriatric acetabular fractures [1, 2]. Geriatric patients often have comorbidities, such as pre-existing coxarthritis, reduced bone quality or limited compliance, which makes injury-adapted follow-up treatment difficult [3]. As a result joint-preserving interventions often fail at an early stage, so that hip arthroplasty is necessary in the short term. The 1‑year mortality after surgically stabilized acetabular fractures is 8.1%, a significant increase by a factor of 4 compared to the age group [4]. This illustrates that differentiated criteria for the indication of joint-preserving surgery versus arthroplasty are necessary to avoid reoperations and complications. Criteria for the indications for primary arthroplasty are fracture type, pre-existing coxarthritis, poor bone quality, limited compliance and patient age (> 75 years) [5, 6].In the following article, three treatment strategies for geriatric acetabular fractures and periprosthetic acetabular fractures are presented; the 1‑stage prosthesis implantation without osteosynthesis, the 1‑stage prosthesis implantation with osteosynthesis and the 2‑stage approach with limited osteosynthesis and early total arthroplasty. The advantages and disadvantages of these options are presented based on cases and the various aspects of the treatment. The treatment of geriatric acetabular fractures is an operative challenge for the surgeon and requires a high level of expertise in both special trauma surgery and revision arthroplasty and thus represents a special interface in the fields of orthopedics and trauma surgery.
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Affiliation(s)
- Claudio Glowalla
- Endoprothetikzentrum der Maximalversorgung, BG Unfallklinik Murnau, Prof. Küntscherstr. 8, 82418, Murnau, Deutschland.
| | - Sven Hungerer
- Endoprothetikzentrum der Maximalversorgung, BG Unfallklinik Murnau, Prof. Küntscherstr. 8, 82418, Murnau, Deutschland
- PMU Salzburg, Salzburg, Österreich
| | - Fabian M Stuby
- Endoprothetikzentrum der Maximalversorgung, BG Unfallklinik Murnau, Prof. Küntscherstr. 8, 82418, Murnau, Deutschland
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10
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Yuan Q, Wang X, Cai Y, Yang M, Zheng H, Zhao X, Ma H, Xu P. Total hip arthroplasty for posttraumatic osteoarthritis secondary to acetabular fracture: An evidence based on 1,284 patients from 1970 to 2018. Front Surg 2022; 9:953976. [PMID: 36439540 PMCID: PMC9684333 DOI: 10.3389/fsurg.2022.953976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/19/2022] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Posttraumatic osteoarthritis (PTOA) can be a crippling sequela of acetabular fracture (AF), and total hip arthroplasty (THA) is often necessary to alleviate the clinical progression of symptoms. The purpose of this study was to summarize the existing clinical evidence concerning the surgical management of AF with THA through meta-analyses. METHODS Databases were searched for articles published between 1995 and January 2022 that contained the keywords "acetabular," "fracture," "arthroplasty," and "osteoarthritis." Our study was registered in PROSPERO under number CRD42022314997. RESULTS We screened 3,125 studies and included data from 31 studies with 1,284 patients. The median patient age at the time of THA was 52 years and ranged from 19 to 94 years. The pooled overall survival rate was 88% [86%-90%, 95% confidence interval (CI)] and could reach 83% at ≥15-year follow-up. For the Harris Hip Score, we pooled 22 studies with an overall mean difference of 43.25 (40.40-46.10, 95% CI; P < 0.001), indicating a large clinical effect. The pooled complications (incidence rates) across studies were: heterotopic ossification (22.53%), implant dislocation (4.66%), implant infection (3.44%), and iatrogenic nerve injury (1.07%). CONCLUSION THA in patients with PTOA following AF leads to significant improvement in symptoms and function at ≥15-year follow-up. Survival rates of implants free from re-operation or revision after THA decreased with follow-up time and could still reach 83% at ≥15-year follow-up. THA might be an effective therapeutic method for patients with PTOA due to AF.
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Affiliation(s)
- Qiling Yuan
- Department of Joint Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Xinyi Wang
- Department of Rehabilitation, Shaanxi Provincial Rehabilitation Hospital, Xi’an, China
| | - Yongsong Cai
- Department of Joint Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Mingyi Yang
- Department of Joint Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Haishi Zheng
- Department of Joint Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Xiaoming Zhao
- Department of Orthopedics of the First Affiliated Hospital, Medical School, Xi’an Jiaotong University, Xi’an, China
| | - Hongyun Ma
- Department of Orthopedics of the First Affiliated Hospital, Medical School, Xi’an Jiaotong University, Xi’an, China
| | - Peng Xu
- Department of Joint Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
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Xiang H, Yang X, Huang Z, Xu W, Chen Y, Li T, Huang H, Fan S. Treatment of Delayed Acetabular Fractures by Periacetabular Osteotomy through the Lateral-Rectus Approach. Orthop Surg 2022; 14:3233-3241. [PMID: 36259635 PMCID: PMC9732581 DOI: 10.1111/os.13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/03/2022] [Accepted: 08/25/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE There has been a controversy in the surgical approach for delayed acetabular fracture. The objective of the present study is to investigate the feasibility, surgical techniques, safety, and efficacy of periacetabular osteotomy using the single lateral-rectus approach (LRA) for the surgical treatment of delayed acetabular fracture. METHODS The retrospective study included 22 patients (16 males and six females, with an average age of 45 years) with delayed acetabular fractures from June 2012 to June 2019. For all cases, periacetabular osteotomy was performed through the single LRA. Fracture classification, mechanism of injury, associated injury, time to surgery, operation time, intraoperative blood loss, and complications were recorded and analyzed. The quality of the reduction was assessed based on Matta radiographic criteria. Potential impact factors affecting the quality of reduction were analyzed. Functional outcome was evaluated at the final follow-up according to a modified Mere D'Aubigne-Postel scoring system for each patient. RESULTS All patients were followed up for at least 12 months. The duration of surgery was 140 min on average (110-205 min) and the mean intraoperative blood loss was 1250 ml (500-2100 ml). According to Matta radiographic criteria, the accuracy of reduction was "anatomical" in seven patients, "imperfect" in 11 patients, and "poor" in four patients, with an excellent and good rate of 81.8%. The time to surgery in poor reduction group was significantly longer than anatomical or imperfect reduction group (p < 0.05). All the acetabular fractures united after 8-12 weeks. The average modified Merle D'Aubigne-Postel score evaluated at the final follow-up was 14.6 (6-18), and the clinical outcomes were rated as excellent in six patients, good in 10 patients, fair in four patients, and poor in two patients, with an excellent and good rate of 72.7%. There were two cases of osteonecrosis of the femoral head (9%). No other complication was found for all cases. CONCLUSION The LRA is an effective and minimally invasive approach in the treatment of delayed acetabular fractures excluding posterior wall fracture and posterior dislocation.
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Affiliation(s)
- Haibo Xiang
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Xiaodong Yang
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina,Department of OrthopaedicHuadu District People's Hospital of GuangzhouGuangzhouChina
| | - Zhuobin Huang
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Wenquan Xu
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Yuhui Chen
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Tao Li
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Hai Huang
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Shicai Fan
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
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El-Bakoury A, Khedr W, Williams M, Eid Y, Hammad AS. The outcome of the uncemented acetabular component in delayed total hip arthroplasty following acetabular fractures. Bone Jt Open 2021; 2:1067-1074. [PMID: 34905940 PMCID: PMC8711662 DOI: 10.1302/2633-1462.212.bjo-2021-0118.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims After failed acetabular fractures, total hip arthroplasty (THA) is a challenging procedure and considered the gold standard treatment. The complexity of the procedure depends on the fracture pattern and the initial fracture management. This study’s primary aim was to evaluate patient-reported outcome measures (PROMs) for patients who underwent delayed uncemented acetabular THA after acetabular fractures. The secondary aims were to assess the radiological outcome and the incidence of the associated complications in those patients. Methods A total of 40 patients underwent cementless acetabular THA following failed treatment of acetabular fractures. The postoperative clinical and radiological outcomes were evaluated for all the cohort. Results The median (interquartile range (IQR)) Oxford Hip Score (OHS) improved significantly from 9.5 (7 to 11.5), (95% confidence interval (CI) (8 to 10.6)) to 40 (39 to 44), (95% CI (40 to 43)) postoperatively at the latest follow-up (p < 0.001). It was worth noting that the initial acetabular fracture type (simple vs complex), previous acetabular treatment (ORIF vs conservative), fracture union, and restoration of anatomical centre of rotation (COR) did not affect the final OHS. The reconstructed centre of rotation (COR) was restored in 29 (72.5%) patients. The mean abduction angle in whom acetabular fractures were managed conservatively was statistically significantly higher than the surgically treated patients 42.6° (SD 7.4) vs 38° (SD 5.6)) (p = 0.032). We did not have any case of acetabular or femoral loosening at the time of the last follow-up. We had two patients with successful two-stage revision for infection with overall eight-year survival rate was 95.2% (95% CI 86.6% to 100%) with revision for any reason at a median (IQR) duration of follow-up 50 months (16 to 87) months following THA. Conclusion Delayed cementless acetabular THA in patients with previous failed acetabular fracture treatments produces good clinical outcomes (PROMS) with excellent survivorship, despite the technically demanding nature of the procedure. The initial fracture treatment does not influence the outcome of delayed THA. In selected cases of acetabular fractures (either nondisplaced or with secondary congruency), the initial nonoperative treatment neither resulted in large acetabular defects nor required additional acetabular reconstruction at the time of THA. Cite this article: Bone Jt Open 2021;2(12):1067–1074.
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Affiliation(s)
- Ahmed El-Bakoury
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK.,El-Hadara University Hospital, Alexandria University, Alexandria, Egypt
| | - Waseem Khedr
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK.,El-Hadara University Hospital, Alexandria University, Alexandria, Egypt
| | - Mark Williams
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Yousry Eid
- El-Hadara University Hospital, Alexandria University, Alexandria, Egypt
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Moon JK, Lee H, Yoon PW, Park KC, Chang JS, Kim JW. Total hip arthroplasty for failed acetabular fracture: a double-center comparative study on failed proximal femur fracture. Eur J Trauma Emerg Surg 2021; 48:2319-2329. [PMID: 34226942 DOI: 10.1007/s00068-021-01744-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to compare the clinical and radiological outcomes of patients who underwent total hip arthroplasty (THA) after failed osteosynthesis of acetabular fractures vs. fractures of the proximal femur. METHODS This is a retrospective comparative study in two centers. A total of 110 patients who underwent THA after osteosynthesis of acetabular or proximal femur fractures were categorized into groups: group 1 (53 patients with acetabular fracture) and group 2 (57 patients with proximal femur fracture). The mean follow-up period was 6.3 (range 2-16.5) years. The Harris hip scores (HHSs), complications, radiological results, and Kaplan-Meier survival curves were evaluated. RESULTS The mean preoperative HHSs of 39.4 (group 1) and 41.2 (group 2) were improved to 83.6 and 84.7 at the final follow-up (p < 0.001 and p < 0.001, respectively). There were two cases of aseptic cup loosening, two cases of septic cup loosening, two cases of deep infection, two cases of dislocation, two cases of sciatic nerve palsy, and one case of periprosthetic fracture in group 1, and one case of dislocation and two cases of infection in group 2, which showed a statistical difference in complication rate (p = 0.021). Total cup migration was significantly higher in group 1 (p = 0.015). After a mean follow-up period of 6.3 years, the survival rate was significantly lower in group 1 (69.4% vs. 97.1%, p = 0.015). CONCLUSION THA following osteosynthesis of acetabular fracture showed poorer survival, higher complication rate, and higher migration of the acetabular cup than THA following osteosynthesis of proximal femur fracture.
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Affiliation(s)
- Jun-Ki Moon
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Ho Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu , Seoul, 05505, Republic of Korea
| | - Pil Whan Yoon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu , Seoul, 05505, Republic of Korea
| | - Ki-Chul Park
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Jae Suk Chang
- Department of Orthopaedic Surgery, Good Gangan Hospital, Busan, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu , Seoul, 05505, Republic of Korea.
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Kumar D, Singh S, Srivastava S, Singh SK, Singh A, Sharma Y. Outcome of total hip arthroplasty in patients with failed open reduction and internal fixation of acetabular fractures. J Clin Orthop Trauma 2021; 20:101480. [PMID: 34262847 PMCID: PMC8253977 DOI: 10.1016/j.jcot.2021.101480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The problem of failed acetabulum fracture fixation is increasing due to increased incidence of high-velocity injury and a large number of patients are being operated on in the past few years. Limited evidence is available regarding results of Total hip arthroplasty (THA) in patients with failed acetabulum fracture fixation surgery. We assessed the clinical, radiological and postoperative complications. Besides this, we also evaluated functional outcome and quality of life following THA in failed open reduction and internal fixation of acetabular fractures. METHOD The current retrospective study was performed at the tertiary center from 2015 to 2020. Eighteen patients of failed acetabulum fracture fixation surgery (14 males and 4 females) were included with a mean follow-up period of 2.4 years. Postero-lateral approach was done in all cases. Clinico-radiological outcome, functional outcomes were recorded according to Harris Hip score (HHS) and quality of life was assessed by using the 12-Item Short Form Health Survey (SF-12) score. Postoperative complications were also assessed. RESULTS The age of patients ranged from 20 years to 68 years with a mean age of 44.7 years. 16 of the patients (88.9%) had a united acetabular fracture while 2 of them (11.1%) presented with un-united acetabular fracture. The THA implant was found to be stable in all 18 cases. The Harris Hip score of the study ranged from 82 to 95 with a mean of 89.72 ± 4.24 while the SF-12 score ranged from 40.0 to 49.4 with a mean of 44.29 ± 2.95. Out of 18 cases, 11 (61.1%) returned with excellent outcomes while the rest 7 (38.9%) returned with good outcomes as per Harris Hips score criteria. The correlation and regression analysis shows between HHS and SF-12 was positive and statistically significant (r = 0.592, p = 0.010). CONCLUSION THA in patients with failed acetabulum fracture fixation surgery provides a reliable option with satisfactory outcomes along with a better quality of life.
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Affiliation(s)
- Dharmendra Kumar
- Corresponding author.304,faculty residence jagat narayan road KGMU, 226003, India.
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Nicol GM, Sanders EB, Kim PR, Beaulé PE, Gofton WT, Grammatopoulos G. Outcomes of Total Hip Arthroplasty After Acetabular Open Reduction and Internal Fixation in the Elderly-Acute vs Delayed Total Hip Arthroplasty. J Arthroplasty 2021; 36:605-611. [PMID: 32919846 DOI: 10.1016/j.arth.2020.08.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Optimum management for the elderly acetabular fracture remains undefined. Open reduction and internal fixation (ORIF) in this population does not allow early weight-bearing and has an increased risk of failure. This study aimed to define outcomes of total hip arthroplasty (THA) in the setting of an acetabular fracture and compared delayed THA after acetabular ORIF (ORIF delayed THA) and acute fixation and THA (ORIF acute THA). METHODS All acetabular fractures in patients older than 60 years who underwent ORIF between 2007 and 2018 were reviewed (n = 85). Of those, 14 underwent ORIF only initially and required subsequent THA (ORIF delayed THA). Twelve underwent an acute THA at the time of the ORIF (ORIF acute THA). The ORIF acute THA group was older (81 ± 7 vs 76 ± 8; P < .01) but had no other demographic- or injury-related differences compared with the ORIF delayed THA group. Outcome measures included operative time, length of stay, complications, radiographic assessments (component orientation, leg-length discrepancy, heterotopic ossification), and functional outcomes using the Oxford Hip Score (OHS). RESULTS Operative time (P = .1) and length of stay (P = .5) for the initial surgical procedure (ORIF only or ORIF THA) were not different between groups. Four patients had a complication and required further surgeries; no difference was seen between groups. Radiographic assessments were similar between groups. The ORIF acute THA group had a significantly better OHS (40.1 ± 3.9) than the ORIF delayed THA group (33.6 ± 8.5) (P = .03). CONCLUSION In elderly acetabulum fractures, ORIF acute THA compared favorably (a better OHS, single operation/hospital visit, equivalent complications) with ORIF delayed THA. We would thus recommend that in patients with risk factors for failure requiring delayed THA (eg, dome or roof impaction) that ORIF acute THA be strongly considered.
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Affiliation(s)
- Graeme M Nicol
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ethan B Sanders
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul R Kim
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Wade T Gofton
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Zhang C, Xiao J. Application of fast-track surgery combined with a clinical nursing pathway in the rehabilitation of patients undergoing total hip arthroplasty. J Int Med Res 2020; 48:300060519889718. [PMID: 31939326 PMCID: PMC7254164 DOI: 10.1177/0300060519889718] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Chunhua Zhang
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jun Xiao
- Department of Joint Osteopathy, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Wang L, Li P, Kou J, Hu C. The effect of previous acetabular fractures on total hip arthroplasty outcomes: A matched-controlled study protocol. Medicine (Baltimore) 2020; 99:e22210. [PMID: 32957355 PMCID: PMC7505324 DOI: 10.1097/md.0000000000022210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is a safe and mature surgical method for the treatment of post-traumatic arthritis and end-stage degenerative osteoarthritis. The cohort study regarding the outcomes of THA following acetabulum fracture is sparse. Therefore, we carried out this present retrospective paired cohort study to study the long-term outcomes of patients receiving THA after the acetabular fracture versus patients receiving THA for the primary osteoarthritis. METHODS Patients with posttraumatic arthritis who received the initial THA after open reduction and internal fixation of acetabular fractures or patients with end-stage degenerative osteoarthritis were included in our study. A retrospective review of patients who receiving the primary total hip arthroplasty in the same institution from 2008 to 2015 was conducted. This present retrospective cohort research was authorized via our hospital institutional review committee. The patients in cohort group were matched 2:1 with the patients in study group according to following criteria: body mass index (±3 points), and age at THA time (±3 years), sex, as well as the score of American Society of Anesthesiologists (±1 point). The measure of primary outcome was the improved Harris Hip Score. Secondary outcomes included surgery time, hip range of motion, revision, complications (infection, loosening, polyethylene wear, dislocation, wound complications, deep vein thrombosis, or pulmonary embolism). RESULTS It was assumed that there is a remarkable difference in postoperative outcomes between the 2 groups. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5921).
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Malunion of the Acetabulum Treated by Intra-articular Buttress. Case Rep Orthop 2020; 2020:8361690. [PMID: 32695540 PMCID: PMC7362281 DOI: 10.1155/2020/8361690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/26/2020] [Indexed: 11/18/2022] Open
Abstract
Acetabulum malunions are extremely difficult to treat, and for many years, surgical indications have been dominated by total hip replacement. We treated a protruding acetabular malunion, 20 years ago, using an intra-articular buttress, by means of an allograft corresponding to a femoral head fragment which had been cryopreserved. The radiological and clinical result with this extended follow-up is quite remarkable, which has motivated us to present this original technique.
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Heyer JH, Thakkar SC, Zittel K, Tozzi JE. Bilateral acetabular fractures treated with delayed total hip arthroplasty. Arthroplast Today 2020; 6:236-240. [PMID: 32577470 PMCID: PMC7303498 DOI: 10.1016/j.artd.2020.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 11/28/2022] Open
Abstract
Acetabular fractures after seizures are uncommon, and fewer than 30 cases are described in the literature. We present a patient with bilateral acetabular fractures after a seizure, with bilateral quadrilateral plate destruction and protrusio deformity. The patient underwent delayed staggered bilateral total hip arthroplasty 3 months after initial injury, with use of the femoral head as autograft for the protrusio deformities.
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Affiliation(s)
- Jessica H Heyer
- Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - Savyasachi C Thakkar
- Department of Orthopaedic Surgery, Medstar Washington Hospital Center, Washington, DC, USA
| | - Kyle Zittel
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - James E Tozzi
- Department of Orthopaedic Surgery, Medstar Washington Hospital Center, Washington, DC, USA
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Highly Cross-Linked Polyethylene in Cementless Total Hip Arthroplasty in Patients with Previous Acetabular Fractures: A Minimum 5-Year Follow-Up Study. Indian J Orthop 2020; 54:239-245. [PMID: 33194097 PMCID: PMC7609683 DOI: 10.1007/s43465-020-00137-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Outcomes of THA after acetabular fracture are generally less favorable than those of the nontraumatic arthritis due to a higher rate of cup loosening and osteolysis. We, therefore, investigated whether highly cross-linked polyethylene liners positively impact outcomes of THA in patients with posttraumatic osteoarthritis after acetabular fracture. METHODS We retrospectively evaluated 39 patients with previous acetabular fracture who underwent THA using highly cross-linked polyethylene liner after a mean 8.5 year follow-up. All procedures were performed at a single institution by a single surgeon using the same type of THA implants. Wear measurements were performed using a computer-assisted PolyWare software. Osteolysis was evaluated with use of radiography and computed tomography. RESULTS The mean preoperative Harris hip score was 44.4 points, which improved to 93.1 points at final follow-up. Neither femoral nor acetabular components displayed mechanical loosening and no components had been revised. Radiographs and CT scans did not demonstrate osteolysis. The mean linear wear was 0.043 mm/y (range 0-0.098 mm/y). With the data available, univariate regression analysis suggests that age, gender, weight, initial fracture type, the duration of follow-up, activity level, liner thickness, acetabular cup inclination, and the necessity of bone graft had no influence on liner penetration. CONCLUSION While the long-term effects of the polyethylene particles from highly cross-linked polyethylene remain unknown, implant survivorship and wear data in this study are promising for this high-risk population. Our encouraging results support the continued use of this type of polyethylene in patients after acetabular fractures. LEVEL OF EVIDENCE Level IV Therapeutic study.
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García-Rey E, Sirianni R, García-Cimbrelo E, Sedel L. Total hip arthroplasty after acetabular fracture: does initial treatment make any difference to the outcome? A 5- to 23-year follow-up with clinical and radiological analysis. Hip Int 2020; 30:339-346. [PMID: 30912452 DOI: 10.1177/1120700019836413] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine if initial treatment affects the outcome of total hip arthroplasty (THA) after acetabular fracture. METHODS 49 patients (49 hips) initially treated non-operatively followed some months later by THA in conjunction with acetabular reconstruction (Group 1) and 29 patients (29 hips) who had undergone THA after a previous osteosynthesis (Group 2) were assessed. The mean follow-up was 11.7 (range 5-23) years. RESULTS 3 acetabular components were revised for aseptic loosening in Group 1 and 2 in Group 2. The survival rate for cup loosening at 16 years was 90.6% (95% confidence interval [CI], 78.1-100) for Group 1 and 94.1% (95% CI, 86.5-100) for Group 2 (p = 0.76). There were 2 sciatic palsies in Group 2 after osteosynthesis. The mean preoperative clinical score and postoperative range of mobility were better in Group 1. There were more heterotopic ossifications in Group 2. CONCLUSION Despite the good results found in both groups, THA after previous osteosynthesis for acetabular fractures had more complications than a primary THA in conjunction with acetabular reconstruction.
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Affiliation(s)
| | - Rossella Sirianni
- Orthopaedic Surgery Department, Versilia Hospital, Lido di Camaiore-Lucca, Italy
| | | | - Laurent Sedel
- Emeritus University of Paris Diderot, Paris, France
- Clinique Saint Jean de Dieu, Paris, France
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Reduced survival for uncemented compared to cemented total hip arthroplasty after operatively treated acetabular fractures. Injury 2017; 48:2534-2539. [PMID: 28882372 DOI: 10.1016/j.injury.2017.08.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/09/2017] [Accepted: 08/31/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Post traumatic arthritis and avascular necrosis of the femoral head are common complications after operatively treated acetabular fractures. This may cause severe disabilities for the patient, necessitating a total hip arthroplasty. Even though an arthroplasty may provide good symptomatic relief, the long-term results are more uncertain and no consensus exists according to preferred prosthetic designs. With this cohort study, we aimed to investigate the medium to long term arthroplasty survival and clinical results of total hip arthroplasty after operatively treated acetabular fractures. METHODS We included 52 patients treated with a secondary total hip arthroplasty at a median of 2.4 (0.1-14.1) years after an operatively treated acetabular fracture. The median age was 54 (11-82) years. Cemented arthroplasty was used for 33 patients, 10 patients had an uncemented arthroplasty and 9 patients received a hybrid arthroplasty. Average follow up was 8.0 (SD 5.0) years. RESULTS Ten-year revision free arthroplasty survival was 79%. Uncemented arthroplasties had a significantly worse 10-year survival of 57%. Arthroplasties performed at a centre without a pelvic fracture service also had a significantly worse 10-years survival of 51%. Cox regression showed similar results with an 8-fold increase in risk of revision for both uncemented arthroplasties and operations performed at a non-pelvic trauma centre. CONCLUSION Total hip arthroplasty secondary to an operatively treated acetabular fracture provides good symptomatic relief. These patients are, however, complex cases and are probably best treated at specialist centres with both pelvic trauma surgeons and arthroplasty surgeons proficient in complex revisions present.
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