Conversion to total hip arthroplasty in posttraumatic arthritis: short-term clinical outcomes

Total hip arthroplasty for posttraumatic osteoarthritis secondary to acetabular fracture: An evidence based on 1,284 patients from 1970 to 2018

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.

Outcome of total hip arthroplasty in patients with failed open reduction and internal fixation of acetabular fractures

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.

Total hip arthroplasty after acetabular fracture surgery

PURPOSE

Acetabular fractures are accompanied by complications such as post-traumatic osteoarthritis (OA) of the hip and avascular necrosis (AVN) of the femoral head. The aim of the study was to evaluate improvement of life quality and functional recovery after total hip arthroplasty (THA) in patients with post-traumatic OA and AVN.

METHODS

We retrospectively reviewed 23 patients with post-traumatic OA of the hip and AVN of the femoral head who undergone THA, out of 63 patients who were previously surgically treated for acetabular fractures. Final functional outcomes are defined according to the Merle d'Aubigné score, and the pain intensity according to VAS from 0 to 10.

RESULTS

Out of 63 patients with acetabular fractures from 2008 to 2018, we analyzed 23 (36.5%) patients, with an average age of 51.5 ± 13.8 years, who required THA due to post-traumatic OA and AVN of the femoral head. THA was done after the average of 4.28 years (range 1 to 8) from previous acetabular osteosynthesis. According to Merle d'Aubigné score, final functional outcomes before THA were moderate with average points of 4.86 (4-6). Post-THA final functional outcomes were excellent with an average point of 10.04 (10-12) (p < 0.001). The ratio of VAS before and after THA was 9.04:1.95(p < 0.001).

CONCLUSION

THA is a method which gives the best results in the treatment of post-traumatic OA of the hip and AVN of the femoral head after previous osteosynthesis of the acetabular fracture. After THA, life quality and functional status of a patient are significantly improved.