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Wilson JM, Abdel MP, Trousdale RT, Lewallen DG, Berry DJ. Total Hip Arthroplasty Following Operative Fixation of Acetabular Fracture: A Contemporary Series. J Arthroplasty 2024; 39:1273-1278. [PMID: 38040067 DOI: 10.1016/j.arth.2023.11.027] [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: 07/21/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is the operation of choice for salvage of post-traumatic arthritis following acetabular fracture. While high failure rates have been reported for these procedures, existing literature reports mainly on historical implant designs and techniques. We aimed to describe implant survivorships, complications, radiographic results, and clinical outcomes of contemporary THA following prior open reduction internal fixation (ORIF) of an acetabular fracture. METHODS We identified 104 patients undergoing THA following prior ORIF of an acetabular fracture from 2000 to 2015 via our institutional total joint registry. Mean age at THA was 50 years (range, 18 to 79 years), 71% were men, and mean body mass index was 27 (range, 18 to 52). All patients were implanted with uncemented acetabular components, and 89% had uncemented stems. Some hardware from prior fixation was retained in 94% of cases. Mean follow-up was 10 years (range, 2 to 21 years). RESULTS The 10-year survivorships free of any revision and any reoperation were 98% and 97%, respectively. There were 4 revisions: 1 each for psoas tendonitis, dislocation, acetabular aseptic loosening, and periprosthetic joint infection. There were 9 complications that did not lead to reoperation: 5 dislocations, 2 periprosthetic femur fractures, 1 sciatic nerve palsy, and 1 case of symptomatic heterotopic ossification. All unrevised components appeared radiographically well-fixed. Mean Harris Hip Score improved from mean 50 preoperatively to mean 82 at 5 years (P < .001). CONCLUSIONS In this series of contemporary THAs following prior acetabular fracture ORIF, revision-free survivorship was excellent with only a single case of acetabular aseptic loosening. These results are encouraging and suggest that contemporary implants and techniques have notably improved on historic results. LEVEL OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Jacob M Wilson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Ramanath SK, Tribhuvan T, Chandran U, Shah RH, Kaushik A, Patil S. Mid-term Results of Total Hip Arthroplasty for Posttraumatic Osteoarthritis after Acetabular Fracture. Hip Pelvis 2024; 36:37-46. [PMID: 38432687 DOI: 10.5371/hp.2024.36.1.37] [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: 05/20/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 03/05/2024] Open
Abstract
Purpose The prognosis of total hip replacement (THR) after open reduction and internal fixation (ORIF) versus THR following non-operative treatment of acetabular fractures is unclear. Few studies have been conducted in this regard. Therefore, the purpose of the current study was to perform an assessment and compare the functional outcomes for study subjects in the ORIF and non-ORIF groups during the follow-up period compared to baseline. Materials and Methods This longitudinal comparative study, which included 40 patients who underwent THR for either posttraumatic arthritis after fixation of an acetabular fracture or arthritis following conservative management of a fracture, was conducted for 60 months. Twenty-four patients had undergone ORIF, and 16 patients had undergone nonoperative/conservative management for acetabular fractures. Following THR, the patients were followed up for monitoring of functional outcomes for the Harris hip score (HHS) and comparison between the ORIF and non-ORIF groups was performed. Results The HHS showed significant improvement in both ORIF and non-ORIF groups. At the end of the mean follow-up period, no significant variation in scores was observed between the groups, i.e., ORIF group (91.61±6.64) compared to non-ORIF group (85.74±11.56). A significantly higher number of re-interventions were required for medial wall fractures and combined fractures compared to posterior fractures (P<0.05). Conclusion THR resulted in improved functional outcome during follow-up in both the groups; however, the ORIF group was observed to have better functional outcome. Re-intervention was not required for any of the posterior fractures at the end of the mean follow-up period.
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Affiliation(s)
| | - Tejas Tribhuvan
- Department of Orthopedics, M S Ramaiah Medical College and Hospital, Bangalore, India
| | - Uday Chandran
- Department of Orthopedics, The Oxford Medical College, Hospital and Research Centre, Bangalore, India
| | - Rahul Hemant Shah
- Department of Orthopedics, M S Ramaiah Medical College and Hospital, Bangalore, India
| | - Ajay Kaushik
- Department of Orthopedics, M S Ramaiah Medical College and Hospital, Bangalore, India
| | - Sandesh Patil
- Department of Orthopedics, M S Ramaiah Medical College and Hospital, Bangalore, India
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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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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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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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Zanchini F, Piscopo A, Nasto LA, Piscopo D, Boemio A, Cacciapuoti S, Iodice G, Cipolloni V, Fusini F. WHICH PROBLEMATICS IN THA AFTER ACETABULAR FRACTURES: EXPERIENCE OF 38 CASES. Orthop Rev (Pavia) 2022; 14:38611. [PMID: 36267215 PMCID: PMC9568415 DOI: 10.52965/001c.38611] [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] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Within a timeframe of 8 years (2008-2016), 38 patients have undergone total hip replacement surgery for coxarthrosis or aseptic necrosis secondary to acetabulum fractures. MATERIALS AND METHODS The study included 27 males and 11 females between 42 and 70 years of age, all of whom came from other institutions. The follow-up period ranged between a minimum of 4.6 and a maximum of 9.7 years. RESULTS At the final follow-up, all patients were evaluated using the Merle D'Aubigne and Pastel model. Optimal results were found in all the cases. Three patients benefited from surgical revisitation with implant exchange following infection and one/two state reimplatation at seven, fourtheen et twenty-seven months respectively. Two patients benefited from cotyle revision due to chronic instability of the implant. CONCLUSIONS The scope of the study was to present all the possible surgical difficulties that can come up with prosthetic implants. More particularly, hip implants after acetabulum fractures qualifies as a "difficult primary implant".
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Affiliation(s)
- Fabio Zanchini
- Department of Orthopaedics, University of Campania "Luigi Vanvitelli", via L. de Crecchio 4, 80138, Naples, Italy
| | - Antonio Piscopo
- Department of Orthopedics and Traumatology, Sacro Cuore di Gesù Fatebenefratelli Hospital, Benevento 82100, Italy
| | - Luigi Aurelio Nasto
- Department of Orthopaedics, University of Campania "Luigi Vanvitelli", via L. de Crecchio 4, 80138, Naples, Italy
| | - Davide Piscopo
- Department of Orthopedics and Traumatology, Sacro Cuore di Gesù Fatebenefratelli Hospital, Benevento 82100, Italy
| | - Alessia Boemio
- Department of Orthopedics and Traumatology, Sacro Cuore di Gesù Fatebenefratelli Hospital, Benevento 82100, Italy
| | - Stefano Cacciapuoti
- Department of Orthopedics and Traumatology, Sacro Cuore di Gesù Fatebenefratelli Hospital, Benevento 82100, Italy
| | - Giuseppe Iodice
- Department of Orthopaedics, University of Campania "Luigi Vanvitelli", via L. de Crecchio 4, 80138, Naples, Italy
| | - Valerio Cipolloni
- Department of Orthopaedics, University of Campania "Luigi Vanvitelli", via L. de Crecchio 4, 80138, Naples, Italy
- Department of Orthopedics and Traumatology, Sacro Cuore di Gesù Fatebenefratelli Hospital, Benevento 82100, Italy
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Mondovì, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Mondovì, Italy
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