1
|
Salášek M, Pavelka T, Rezek J, Šídlo K, Šimánek M, Whitley A, Džupa V. Mid-term functional and radiological outcomes after total hip replacement performed for complications of acetabular fractures. Injury 2023:110916. [PMID: 37394328 DOI: 10.1016/j.injury.2023.110916] [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: 04/20/2023] [Revised: 06/14/2023] [Accepted: 06/25/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Acetabular fractures can lead to serious complications such as avascular necrosis of the femoral head (AVN), osteoarthritis, non-union. Total hip replacement (THR) is a treatment option for these complications. The purpose of this study was to assess the functional and radiological outcomes of THR at least 5 years after the primary implantation. METHODS This retrospective study analysed clinical data from 77 patients (59 males, 18 females) who were treated from 2001 to 2022. Data was collected on the incidence of AVN of the femoral head, complications, interval from fracture to THR, reimplantation. The modified Harris Hip Score (MHHS) was used to evaluate outcome. RESULTS The mean age at the time of fracture was 48 years. Avascular necrosis developed in 56 patients (73%), with 3 cases of non-union. Osteoarthritis without AVN developed in 20 patients (26%), non-union without AVN in one patient (1%). The mean time from fracture to THR was 24 months for AVN with non-union, 23 months for AVN alone, 22 months for AVN with arthritis, 49 months for hip osteoarthritis without AVN. The time interval was significantly shorter for cases of AVN than for cases of osteoarthritis without AVN (p = 0.0074). Type C1 acetabular fracture was found to be a risk factor for femoral head AVN (p = 0.0053). Common complications of acetabular fractures included post-traumatic sciatic nerve paresis (17%), deep venous thrombosis (4%), infections (4%). Hip dislocation was the most common complication of THR (17%). There were no cases of thrombosis following THR. According to Kaplan-Meier analysis, the proportion of patients without revision surgery within 10-year period was 87.4% (95% CI 86.7-88.1). The results of the MHHS after THR: 59.3% of patients had excellent results, 7.4% good, 9.3% satisfactory results, and 24.0% had poor results. The mean MHHS was 84 points (95% CI 78.5-89.5). Paraarticular ossifications were observed in 69.4% of patients in the radiological evaluation. CONCLUSION Total hip replacement is an effective treatment for serious complications of acetabular fracture treatment. Its results are comparable to THR peformed for other indications, although it is associated with a higher number of paraarticular ossifications. Type C1 acetabular fracture was found to be a significant risk factor for early femoral head AVN.
Collapse
Affiliation(s)
- Martin Salášek
- Department of Orthopaedics and Traumatology, Faculty of Medicine of Charles University, and University Hospital, Pilsen, Czech Republic; New Technologies for the Information Society, Facult of Applied Sciences, University of West Bohemia, Pilsen, Czech Republic.
| | - Tomáš Pavelka
- Department of Orthopaedics and Traumatology, Faculty of Medicine of Charles University, and University Hospital, Pilsen, Czech Republic
| | - Jan Rezek
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Kryštof Šídlo
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Miroslav Šimánek
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic; Department of Orthopaedics, Hospital Sokolov, Czech Republic
| | - Adam Whitley
- Department of Surgery, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic; Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Valér Džupa
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic; Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| |
Collapse
|
2
|
Chen L, Sun S, Wang Q, Bahete A, Cai L, Kang P. Comparison of Perioperative Outcomes and Early Complications Between a Direct Anterior Approach or Posterolateral Approach in Simultaneous Bilateral Total Hip Arthroplasty: A Retrospective Study. HSS J 2023; 19:172-179. [PMID: 37065100 PMCID: PMC10090840 DOI: 10.1177/15563316221145688] [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: 07/20/2022] [Accepted: 11/11/2022] [Indexed: 01/15/2023]
Abstract
Background: Controversies remain on the best surgical approaches for unilateral total hip arthroplasty (THA). There are little data on simultaneous bilateral THA via direct anterior approach (SimBDAA-THA) or posterolateral approach (SimBPA-THA). Purpose: We sought to assess differences in perioperative outcomes and early medical and surgical complications between SimBDAA-THA and SimBPA-THA. Methods: This retrospective study involved patients who underwent either SimBDAA-THA in a supine position (n = 73) or SimBPA-THA in a lateral position (n = 162) at our institution from January 2015 to November 2021. The 2 groups were compared in terms of clinical and demographic characteristics, surgical parameters, and complications during 6-months of follow-up. Results: There were no differences in clinical and demographic characteristics between the 2 groups prior to surgery. Simultaneous bilateral THA via direct anterior approach significantly shortened the length of both the operation (117.50 ±19.42 vs 143.97 ± 32.20 min) and the hospitalization (140.64 ± 43.22 vs 156.24 ± 56.64 h) but increased perioperative loss of hemoglobin (3.28 ± 1.01 vs 3.21 ± 2.26 g/dL). There were no significant differences between the two groups in transfusion rate; levels of interleukin-6, C-reactive protein or creatine kinase; or complications. Conclusion: This retrospective study of patients at a single institution found minimal differences in perioperative outcomes or early medical and surgical complications between SimBDAA-THA and SimBPA-THA except operative time and length of hospitalization. Larger studies with longer follow-up should be conducted to identify whether a direct anterior approach is superior to a posterolateral one.
Collapse
Affiliation(s)
- Liyile Chen
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Shuo Sun
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Qiuru Wang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Aergen Bahete
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Lijun Cai
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Pengde Kang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Operative management of acetabular fractures in the elderly: a case series. Eur J Trauma Emerg Surg 2022; 49:1011-1021. [PMID: 36261732 PMCID: PMC10175464 DOI: 10.1007/s00068-022-02129-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/01/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Our objective was to identify acetabular fractures in the elderly population (over 60 years of age), treated with open reduction and internal fixation (ORIF), and to examine their outcomes, primarily the risk for need for further surgery in the form of a total hip arthroplasty (THA), and factors associated with it. Additional outcomes such as infection, avascular necrosis (AVN) of the femoral head, and heterotopic ossification (HO) were also investigated. METHODS Following institutional review board (IRB) approval, a retrospective analysis of all consecutive patients presenting to a Level I Trauma Centre over a 13-years period (January 2003-February 2016) was conducted. Patients were excluded if their initial treatment was conservative or simultaneous ORIF with THA. RESULTS A total of 62 patients with an age of 71.5 ± 8.04 years were included (14 female; follow-up 54.2 months, range 1-195 months). Sixteen patients required a THA as a secondary procedure due to symptomatic post-traumatic arthritis (25.8%), five (8.1%) of whom having a THA within a year from the original trauma (three patients presenting with loss of reduction and two patients with early AVN). No associations with progression to THA were identified. Surgical approach (ilioinguinal) was the only factor associated with increased risk of development of HO (p = 0.010). The median post-operative survival following an acetabular fracture treated with ORIF was calculated at 90.1 months (95% CI 72.9-107.2). CONCLUSION Acetabular fractures ORIF in the elderly, is a safe and reliable option. The relatively incidence of development of severe post-operative arthritis was 45.2%. Conversion to THA was 25.8%, with 8.1% having the arthroplasty procedure within a year of the original trauma surgery. LEVEL OF EVIDENCE III.
Collapse
|