Total hip arthroplasty, combined with a reinforcement ring and posterior column plating for acetabular fractures in elderly patients: good outcome in 34 patients

Abstract

Background and purpose — Low-energy acetabulum fractures are uncommon, and mostly occur in elderly patients. Determining the optimal operative treatment for such fractures is challenging. Here we investigated whether acutely performed total hip arthroplasty plus posterior column plating (THA) reduced complications and reoperations compared with open reduction and internal fixation (ORIF) in elderly patients with acetabular fractures. Patients and methods — We retrospectively reviewed the records of 59 patients, > 55 years of age, with complex acetabular fractures, caused by low-energy trauma, treated between January 2008 and September 2017. Of these patients, 34 underwent acute THA, and 25 ORIF alone. Patient and implant survival were compared between groups using Kaplan–Meier survival analysis and Cox multiple regression. Functional outcomes assessed by Oxford Hip Score (OHS) were compared between the THA patients and those 9 ORIF patients who underwent secondary THA due to posttraumatic hip osteoarthritis (OA) during follow-up. Results — Overall patient survival was 90% (95% CI 82–98) at 12 months, and 64% (CI 47–81) at 5 years. Of 25 ORIF patients, 9 required secondary THA due to posttraumatic OA. Large fragments on the weight-bearing acetabular dome upon imaging predicted ORIF failure and secondary THA. The acute THA group and secondary THA group had similar 12-month OHS. Interpretation — Acute THA including a reinforcement ring resulted in fewer reoperations than ORIF alone in elderly patients with acetabular fractures. These findings support acute THA as first-line treatment for complex acetabular fractures in elderly patients.

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

“…Quadrilateral plate comminution was associated with poor post-operative reduction and low HHS [ 24 ]. We reported a higher revision rate in the ORIF group than in the DM-CHP group essentially represented by secondary THA, which is in accordance with the results of others study [ 10 , 14 ] and systematic review [ 8 ].…”

“…The stability of the posterior column was one of the essential factors of the surgical strategy. More recently, Lont et al [ 14 ] had shown the importance of posterior column stabilization associated with the prevention of central migration using a posterior column plate and an antiprotrusion cage. Stabilization of the posterior column only in acute THA leads to reduced operation time, easier approach, and low post-operative complications [ 14 ].…”

“…More recently, Lont et al [ 14 ] had shown the importance of posterior column stabilization associated with the prevention of central migration using a posterior column plate and an antiprotrusion cage. Stabilization of the posterior column only in acute THA leads to reduced operation time, easier approach, and low post-operative complications [ 14 ]. Mean surgery time was lower [ 10 , 14 , 22 ], mean blood loss was lower [ 10 ] or similar [ 14 , 22 ], and mean HHS was higher for Tidemark et al [ 22 ] in comparison with our CA-CHP group.…”

“…Stabilization of the posterior column only in acute THA leads to reduced operation time, easier approach, and low post-operative complications [ 14 ]. Mean surgery time was lower [ 10 , 14 , 22 ], mean blood loss was lower [ 10 ] or similar [ 14 , 22 ], and mean HHS was higher for Tidemark et al [ 22 ] in comparison with our CA-CHP group. On the other hand, Rickman et al [ 12 ] used combined approaches on 20 elderly patients with only two post-operative complications.…”

“…Compared with ORIF, there is no need for an anatomic reduction, but there must be an adequate stability and bone stock to achieve THA. This surgical procedure allows for early mobilization with total weight-bearing [ 12 ], which should theoretically lead to fewer post-operative complications [ 14 ].…”