Mears, J Bone Joint Surg Am 2002 - Acute Total Hip Arthroplasty for Selected Displaced Acetabular Fractures

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Acute Total Hip Arthroplasty for Selected Displaced Acetabular Fractures

Mears, Velyvis·J Bone Joint Surg Am·2002·264 citations·Case series

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Background

We assessed the role of acute total hip arthroplasty in a selected group of patients with a displaced acetabular fracture and complicating features that greatly diminished the likelihood of a favorable outcome after open reduction and internal fixation.

Methods

Between 1985 and 1997, 57 patients underwent an acute total hip arthroplasty for a displaced acetabular fracture.
Patients were followed for a mean of 8.1 years (range, 2 to 12 years).
The mean time from the injury to the arthroplasty was 6 days (range, one to 20 days).
The mean age of the patients at the time of the arthroplasty was 69 years (range, 26 to 89 years).
Indications for the acute arthroplasty included intra-articular comminution as well as full-thickness abrasive loss of the articular cartilage, impaction of the femoral head, and impaction of the acetabulum that involved >40% of the joint surface and included the weight-bearing region.

Results

At the time of the latest follow-up, the mean Harris hip score was 89 points (range, 69 to 100 points); 45 patients (79%) had an excellent or good outcome.
There were 6 cases of heterotopic bone formation, including one of symptomatic grade-IV ossification.
During the initial 6 postoperative weeks, the acetabular cups subsided an average of 3 mm medially and 2 mm vertically.
All of the cups then stabilized, and none were loose at the latest follow-up evaluation.
6 patients had excessive medialization of the cup, but none had late loosening or osteolysis.
9 cups (16%) had notable polyethylene wear, but none were revised.
No cup or stem had late clinical or radiographic evidence of loosening.
There were 3 late procedures: one for revision of a malaligned cup because of recurrent dislocations, one for removal of hardware from the greater trochanter, and one for excision of heterotopic bone.

Conclusions

In selected patients with a displaced acetabular fracture that has a low likelihood of a favorable outcome after fracture treatment, an acute total hip arthroplasty may provide an alternative means with which to achieve a painless, mobile hip. These complex procedures are best undertaken by a surgical team with substantial experience with both acetabular trauma and hip arthroplasty.

Copyright remains with the authors and publisher.

Acute Total Hip Arthroplasty for Selected Displaced Acetabular Fractures

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Acute Total Hip Arthroplasty for Selected Displaced Acetabular Fractures

Mears, Velyvis·J Bone Joint Surg Am·2002·264 citations·Case series

|

Background

We assessed the role of acute total hip arthroplasty in a selected group of patients with a displaced acetabular fracture and complicating features that greatly diminished the likelihood of a favorable outcome after open reduction and internal fixation.

Methods

Between 1985 and 1997, 57 patients underwent an acute total hip arthroplasty for a displaced acetabular fracture.
Patients were followed for a mean of 8.1 years (range, 2 to 12 years).
The mean time from the injury to the arthroplasty was 6 days (range, one to 20 days).
The mean age of the patients at the time of the arthroplasty was 69 years (range, 26 to 89 years).
Indications for the acute arthroplasty included intra-articular comminution as well as full-thickness abrasive loss of the articular cartilage, impaction of the femoral head, and impaction of the acetabulum that involved >40% of the joint surface and included the weight-bearing region.

Results

At the time of the latest follow-up, the mean Harris hip score was 89 points (range, 69 to 100 points); 45 patients (79%) had an excellent or good outcome.
There were 6 cases of heterotopic bone formation, including one of symptomatic grade-IV ossification.
During the initial 6 postoperative weeks, the acetabular cups subsided an average of 3 mm medially and 2 mm vertically.
All of the cups then stabilized, and none were loose at the latest follow-up evaluation.
6 patients had excessive medialization of the cup, but none had late loosening or osteolysis.
9 cups (16%) had notable polyethylene wear, but none were revised.
No cup or stem had late clinical or radiographic evidence of loosening.
There were 3 late procedures: one for revision of a malaligned cup because of recurrent dislocations, one for removal of hardware from the greater trochanter, and one for excision of heterotopic bone.

Conclusions

In selected patients with a displaced acetabular fracture that has a low likelihood of a favorable outcome after fracture treatment, an acute total hip arthroplasty may provide an alternative means with which to achieve a painless, mobile hip. These complex procedures are best undertaken by a surgical team with substantial experience with both acetabular trauma and hip arthroplasty.

Copyright remains with the authors and publisher.

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