Acute Total Hip Arthroplasty for Selected Displaced Acetabular Fractures: Two to Twelve-Year Results

• Published in: Journal of bone and joint surgery. American volume Vol. 84; no. 1; pp. 1 - 9
• Main Authors: Mears, Dana C, Velyvis, John H
• Format: Journal Article
• Language: English
• Published: Boston, MA Copyright by The Journal of Bone and Joint Surgery, Incorporated 01.01.2002; Journal of Bone and Joint Surgery Incorporated
• Subjects: Acetabulum - injuries; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - methods; Biological and medical sciences; Female; Follow-Up Studies; Fractures, Bone - diagnostic imaging; Fractures, Bone - surgery; Humans; Male; Medical sciences; Middle Aged; Orthopedic surgery; Osteolysis - etiology; Postoperative Complications; Radiography; Reoperation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Human; Postoperative; Prognosis; Indication; Prosthesis; Diseases of the osteoarticular system; Lower limb; Acetabulum; Osteosynthesis; Fracture; Pelvis bone; Trauma; Long term; Hip; Orthopedic surgery; Treatment; Pelvis pathology; Total; Complication; Technique
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200201000-00001

BackgroundWe 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.MethodsBetween 1985 and 1997, fifty-seven patients underwent an acute total hip arthroplasty for a displaced acetabular fracture. Patients were followed for a mean of 8.1 years (range, two to twelve years). The mean time from the injury to the arthroplasty was six days (range, one to twenty days). The mean age of the patients at the time of the arthroplasty was sixty-nine years (range, twenty-six to eighty-nine 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.ResultsAt the time of the latest follow-up, the mean Harris hip score was 89 points (range, 69 to 100 points); forty-five patients (79%) had an excellent or good outcome. There were six cases of heterotopic bone formation, including one of symptomatic grade-IV ossification. During the initial six 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. Six patients had excessive medialization of the cup, but none had late loosening or osteolysis. Nine cups (16%) had notable polyethylene wear, but none were revised. No cup or stem had late clinical or radiographic evidence of loosening. There were three late proceduresone 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.ConclusionsIn 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.