Percutaneous Column Fixation and Total Hip Arthroplasty for the Treatment of Acute Acetabular Fracture in the Elderly

Chakravarty, Rajit; Toossi, Nader; Katsman, Anna; Cerynik, Douglas L.; Harding, Susan P.; Johanson, Norman A.

doi:10.1016/j.arth.2013.08.009

Cited by 25 publications

(21 citation statements)

References 21 publications

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“…The characteristics of the included studies are shown in Table 1. A total of 13 studies 5,7-16,18,19 are retrospective and two 6,17 are prospective. According to the Letournel and Judet fracture classification system, 21 elementary patterns were reported in 29.9% of cases while complex patterns were reported in 70.1% of the patients.…”

Section: Resultsmentioning

confidence: 99%

Surgical treatment of acetabular fractures in the elderly: a systematic review of the results

2017

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We performed a systematic review of the literature involving a number of databases to identify studies that included outcomes of surgical treatment of acetabular fractures in patients aged > 55 years. An initial search identified 1564 studies. After exclusion by two independent reviewers, 15 studies met the inclusion criteria. All studies were case series and the mean Coleman Methodology score for methodological quality assessment was 43.7 (standard deviation 12.3). There were 354 patients with acetabular fractures. Pooled analysis revealed a mean age of 71.6 years (55 to 96) and a mean follow-up of 43 months (20 to 188). Complex fractures were reported in 70.1% of patients.Seven studies presented the results of open reduction and internal fixation (ORIF); in eight other studies a total hip arthroplasty (THA), alone or combined with different internal fixation techniques, was the chosen treatment. In the ORIF sub-group, conversion to THA was performed at a mean of 25.5 months with anatomical reduction in 11.6% and imperfect and poor reduction in 22.3%. In the THA sub-group, an acetabular ring or cage with a cemented acetabular component was used in four studies (52 patients) and a cementless acetabular component was implanted in five studies (78 patients). Six patients (4.9%) underwent revision at a mean of 39 months after the index procedure.The analysis of intra-operative and post-operative parameters showed a statistical difference between the two sub-groups with regards to the mean operating time (236 mins ORIF vs 178 mins THA), the mean blood loss (707 mL ORIF vs 974 mL THA) and the mean mortality rate at one year (22.6% ORIF vs 8.8% THA).Based on the current data available, acute THA (alone or in combination with internal fixation) may have a role in the treatment of older patients with complex acetabular fractures. Despite the wide heterogenecity of fracture types and patient co-morbidities, THA procedures were associated with lower rates of mortality and further surgery when compared with the ORIF procedures.Cite this article: EFORT Open Rev 2017;2:97-103. DOI: 10.1302/2058-5241.2.160036

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Section: Resultsmentioning

confidence: 99%

Surgical treatment of acetabular fractures in the elderly: a systematic review of the results

2017

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“…In 34 hips in 33 patients who had a mean age of 49.8 years (range, 19-78), there were nine acetabular revisions at mean follow-up of approximately 12 years (range, [10][11][12][13][14][15][16]. Of the 26 acetabular components with a minimum 10 years follow-up, only two were loose.…”

Section: Implant Survivorshipmentioning

confidence: 97%

“…The use of bone grafting with cementation has also shown good implant survivorship. Schreurs et al [34] (n = 20 patients) had only two patients revised at a follow-up of 9.5 years (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. One was revised for septic loosening and the other for aseptic loosening at 14.5 years and 15.3 years, respectively.…”

Section: Implant Survivorshipmentioning

confidence: 99%

“…Acetabular defects were treated with autograft and/or allograft bone chips with a cemented all-polyethylene cup. At a follow-up of 9.5 years (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], the mean HHS was 93 points (range, 62-100 points) in the 16 surviving patients, 14 who were pain free. Zhang et al [28] assessed the ability to restore hip center using an acetabular reinforcement ring and a cemented cup in patients treated with prior open reduction internal fixation (n = 49 hips).…”

Section: Harris Hip Scoresmentioning

confidence: 99%

“…Therefore, many surgeons currently treat these injuries surgically depending on the magnitude of displacement and fracture pattern with various strategies, including percutaneous fixation [12][13][14], open reduction internal fixation [15,16] or hip arthroplasty [17,18]. Even when operative treatment goals are achieved, arthritis can develop in up to 30% of patients [1,2,7,19,20].…”

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confidence: 99%

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Outcomes of delayed total hip arthroplasty in patients with a previous ipsilateral acetabular fracture

Jauregui

Banerjee

et al. 2015

Expert Review of Medical Devices

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Post-traumatic arthritis of the hip can develop in 12-57% of patients after an acetabular fracture. Once it develops, salvage treatment options include arthroplasty or arthrodesis. Delayed total hip arthroplasty (THA) has been shown to be a viable treatment option to decrease pain, improve stability and increase functional outcomes. Using cemented designs, earlier long-term studies reported satisfactory functional outcomes of delayed THA used to treat previously failed acetabular fractures. However, high aseptic loosening rates were also observed. Recent advances in cementless acetabular designs have shown comparable functional outcomes and loosening rates compared to those undergoing THA for non-traumatic arthritis. However, even with improvements in functional and radiographic outcomes, unique complications are commonly encountered in patients with previous acetabular fractures, including heterotopic bone around the hip, increased operative times and blood loss, aseptic loosening, sciatic nerve injury and dislocation. The outcomes and complications of delayed THA in patients with previous acetabular fracture will be reviewed.

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Outcomes of Treatment Options for Acetabular Fractures in Older Patients

O’Toole

2019

Acetabular Fractures in Older Patients

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Percutaneous Column Fixation and Total Hip Arthroplasty for the Treatment of Acute Acetabular Fracture in the Elderly

Cited by 25 publications

References 21 publications

Surgical treatment of acetabular fractures in the elderly: a systematic review of the results

Surgical treatment of acetabular fractures in the elderly: a systematic review of the results

Outcomes of delayed total hip arthroplasty in patients with a previous ipsilateral acetabular fracture

Outcomes of Treatment Options for Acetabular Fractures in Older Patients

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