The outcome of the uncemented acetabular component in delayed total hip arthroplasty following acetabular fractures

Abstract

Aims After failed acetabular fractures, total hip arthroplasty (THA) is a challenging procedure and considered the gold standard treatment. The complexity of the procedure depends on the fracture pattern and the initial fracture management. This study’s primary aim was to evaluate patient-reported outcome measures (PROMs) for patients who underwent delayed uncemented acetabular THA after acetabular fractures. The secondary aims were to assess the radiological outcome and the incidence of the associated complications in those patients. Methods A total of 40 patients underwent cementless acetabular THA following failed treatment of acetabular fractures. The postoperative clinical and radiological outcomes were evaluated for all the cohort. Results The median (interquartile range (IQR)) Oxford Hip Score (OHS) improved significantly from 9.5 (7 to 11.5), (95% confidence interval (CI) (8 to 10.6)) to 40 (39 to 44), (95% CI (40 to 43)) postoperatively at the latest follow-up (p < 0.001). It was worth noting that the initial acetabular fracture type (simple vs complex), previous acetabular treatment (ORIF vs conservative), fracture union, and restoration of anatomical centre of rotation (COR) did not affect the final OHS. The reconstructed centre of rotation (COR) was restored in 29 (72.5%) patients. The mean abduction angle in whom acetabular fractures were managed conservatively was statistically significantly higher than the surgically treated patients 42.6° (SD 7.4) vs 38° (SD 5.6)) (p = 0.032). We did not have any case of acetabular or femoral loosening at the time of the last follow-up. We had two patients with successful two-stage revision for infection with overall eight-year survival rate was 95.2% (95% CI 86.6% to 100%) with revision for any reason at a median (IQR) duration of follow-up 50 months (16 to 87) months following THA. Conclusion Delayed cementless acetabular THA in patients with previous failed acetabular fracture treatments produces good clinical outcomes (PROMS) with excellent survivorship, despite the technically demanding nature of the procedure. The initial fracture treatment does not influence the outcome of delayed THA. In selected cases of acetabular fractures (either nondisplaced or with secondary congruency), the initial nonoperative treatment neither resulted in large acetabular defects nor required additional acetabular reconstruction at the time of THA. Cite this article: Bone Jt Open 2021;2(12):1067–1074.

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

“…Meta-regressions based on variables, such as age, the proportion of females, and the interval between fracture and THA were conducted, and no statistically significant correlation was observed between these variables and effect size ( P > 0.05) ( Supplementary Figure S2 ). For OHS, four studies ( 13 , 14 , 26 , 27 ) with an MD of 25.22 were pooled, indicating a large effect (19.99–30.46; P < 0.001) ( Supplementary Figure S3 ). Significant heterogeneity was found among these four studies ( I 2 = 94.3%, P < 0.001).…”

“…Ten studies ( 1 , 13 , 14 , 24 – 27 , 32 , 35 , 37 ) divided the patients into ORIF and CST groups based on the primary treatment methods after AF. For survival rate, six studies ( 13 , 14 , 25 , 26 , 32 , 37 ) were pooled with RR of 0.93 (0.86 to 1.00, 95% CI), which was in favor of the CST group ( P < 0.05) ( Figure 7 ). No significant heterogeneity was found across these studies ( I 2 = 0%, P = 0.588).…”

“…No significant heterogeneity was found across these studies ( I 2 = 0%, P = 0.588). For clinical outcomes (HHS and OHS), eight studies ( 1 , 13 , 14 , 24 – 27 , 35 ) were pooled with a standardized mean difference (SMD) of 0.20 (−0.19 to 0.58, 95% CI) and with no significant difference between the ORIF and CST groups ( Figure 8 ).…”

Total Hip Arthroplasty in the Setting of Post-Traumatic Arthritis Following Acetabular Fracture: A Systematic Review

“…Additionally, over the studied time frame, there may have been variation in diagnostic criteria and tools which may have affected reporting of results. Our initial search found a number of studies from the same institution with overlapping patient groups [ [51] , [52] , [53] , [54] ], whereby the series of the largest cohort was selected for inclusion. Statistical analysis for subgroups was limited due to discrepancies in reporting of results amongst included studies.…”

Which Problematics in Tha After Acetabular Fractures: Experience of 38 Cases

“…In other terms, the above-mentioned parameters are prognostically significant for future implantation. [1][2][3][4][5][6] Modest initial acetabular deformation and conservative treatment are two favourable parameters for an uncomplicated hip arthroplasty. [7][8][9] On the contrary, complex fracture patterns, bad reduction, pseudoarthrosis, previous surgeries, infections, devices, dense wound tissue and heterotopic ossification, can gravely complication a hip arthroplasty procedure.…”