Outcomes of combined hip procedure with dual mobility cup versus osteosynthesis for acetabular fractures in elderly patients: a retrospective observational cohort study of fifty one patients

Abstract

Purposes Acetabular fractures are more and more common in the elderly. Open reduction and internal fixation (ORIF) may lead to poor outcomes and high revision rates. Primary total hip arthroplasty (THA) combined with internal fixation, also known as the combined hip procedure (CHP), associated with dual mobility cup (DM-CHP) could be an efficient procedure in selected elderly patients. The aim of this study is to compare functional and radiological outcomes between ORIF and DM-CHP. Methods Between 2007 and 2018, 51 patients older than 65 years were surgically treated for acetabular fractures. Twenty-six patients were treated by DM-CHP and 25 by ORIF. Each group was divided into two subgroups regarding a single or combined approach. Hospital stay, surgical time, intraoperative blood loss, and complications were documented. The Harris Hip Score (HHS) was used for measuring the functional outcome. Radiological analysis was used to assess the centre of rotation in the DM-CHP group. Results Median surgery time and intra-operative blood loss were higher in DM-CHP than those in ORIF. Early medical complication rate was higher for a combined approach as compared with a single posterior approach in DM-CHP (p = 0.003). Dislocation rate was 7.7% in DM-CHP. Revision rate was higher in ORIF (20% versus 7.7%). HHS was similar in both groups. Conclusions DM-CHP leads to similar functional outcomes and less revision than ORIF. This study strengthens the practice of using only the posterior approach for primary THA in the elderly. Dual mobility is a valid therapeutic option for acetabular fractures in elderly patients.

Outcome of surgically treated acetabular fractures: risk factors for postoperative complications and for early conversion to total hip arthroplasty

“…We have not administered indomethacin as a protective drug because its e cacy is still controversial [39][40]. The rate of this complication is in accordance with the literature [1,39]. The analysis of our cohort reports posterior surgical approach (P=0.031) and ISS value > 15 (P= 0.0003) as signi cant risk factors.…”

“…The incidence of HO in our population is 20,1%. We have not administered indomethacin as a protective drug because its e cacy is still controversial [39][40]. The rate of this complication is in accordance with the literature [1,39].…”

“…Four of them had developed AVNFH, 3 HO (Brooker IV) and 4 OA. Several studies showed similar rates of THA, between 18% and 24%, despite different FU intervals [18,39]. In our population, anatomical reduction was obtained in more than 70% of fractures, which probably explains the relatively low rate of conversion to THA.…”

Is Cemented Dual-Mobility Cup a Reliable Option in Primary and Revision Total Hip Arthroplasty: A Systematic Review

“…The full texts of the remaining 86 articles were examined. Finally, according to the eligibility criteria, 56 articles were included in the systematic review [ 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ] ( Figure 1…”

Current trends in the treatment of acetabular fractures (literature review)

“…Контроверсійність питання пов'язана, на нашу думку, із різними підходами в ортопедичних центрах, які стикаються переважно з наслідками травми та низькоенергетичними ушкодженнями на фоні структурних змін кісткової тканини, й тими відділеннями невідкладної травматології та політравми, пацієнтами яких є особи молодого віку після високоенергетичних травм, нечасто з множинними ушкодженнями, у стані шоку. Відповідно, у першому випадку підготовка хірургів, досвід виконання ревізійних складних реконструктивних операцій зумовлює схильність до ендопротезування, а в центрах невідкладної травматології бригади, що мають великий досвід остеосинтезу, наголошують на недоцільності ендопротезування [39].…”