Total Hip Arthroplasty After Acetabular Fractures in the Older Population: Timing of Intervention May Be Everything for Success

Abstract Purpose To investigate the range of indications of an anatomical-preshaped three-dimensional suprapectineal plate and to assess the impact of the bone mass density on radiologic outcomes in different types of acetabular fractures. Patients and methods A consecutive case series of 50 acetabular fractures (patient age 69 ± 23 years) treated with suprapectineal anatomic plates were analyzed in a retrospective study. The analysis included: Mechanism of injury, fracture pattern, surgical approach, need for additional total hip arthroplasty, intra- or postoperative complications, as well as bone mass density and radiological outcome on postoperative computed tomography. Results Most frequently, anterior column fracture patterns with and without hemitransverse components as well as associated two column fractures were encountered. The anterior intrapelvic approach (AIP) was used in 98% (49/50) of the cases as primary approach with additional utilization of the first window of the ilioinguinal approach in 13/50 cases (26%). Determination of bone density revealed impaired bone quality in 70% (31/44). Postoperative steps and gaps were significantly greater in this subgroup (p < 0.05). Fracture reduction quality for postoperative steps revealed anatomic results in 92% if the bone quality was normal and in 46% if impaired (p < 0.05). In seven cases (14%), the plate was utilized in combination with acute primary arthroplasty. Conclusion A preshaped suprapectineal plate provides good radiological outcomes in a variety of indications in a predominantly geriatric cohort. Impaired bone quality has a significantly higher risk of poor reduction results. In cases with extensive joint destruction, the combination with total hip arthroplasty was a valuable option.

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Letter regarding “Open reduction and internal fixation alone versus open reduction and internal fixation plus total hip arthroplasty for displaced acetabular fractures in patients older than 60 years: A prospective clinical trial”

Injury ◽

10.1016/j.injury.2021.11.056 ◽

2021 ◽

Author(s):

Shiho Oide ◽

Masahiro Banno ◽

Akihiro Saitsu ◽

Natsumi Saka

Keyword(s):

Clinical Trial ◽

Total Hip Arthroplasty ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Open Reduction ◽

Prospective Clinical Trial ◽

Acetabular Fractures ◽

Total Hip

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Open Reduction and Internal Fixation Versus Total Hip Arthroplasty for the Treatment of Acute Displaced Acetabular Fractures

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200211000-00033 ◽

2002 ◽

Vol 84 (11) ◽

pp. 2103-2104 ◽

Cited By ~ 8

Author(s):

Paul E. Beaulé

Keyword(s):

Total Hip Arthroplasty ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Open Reduction ◽

Acetabular Fractures ◽

Total Hip

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Acetabular Fractures in the Elderly

Clinical Medicine Insights Trauma and Intensive Medicine ◽

10.4137/cmtim.s12265 ◽

2015 ◽

Vol 6 ◽

pp. CMTIM.S12265 ◽

Cited By ~ 1

Author(s):

Joshua L. Gary

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Acetabular Fracture ◽

Open Reduction ◽

Weight Bearing ◽

Revision Arthroplasty ◽

Early Mobilization ◽

Acetabular Fractures ◽

Posttraumatic Arthritis ◽

Total Hip

As the population ages, the incidence of osteoporotic fractures, including those of the pelvis and acetabulum, continues to rise. Treatment of the elder patients with an acetabular fracture is much more controversial than the treatment of younger patients with similar injuries, where prevention of posttraumatic arthritis and total hip replacement remains optimal to limit need for revision arthroplasty. Arthroplasty for fractures of the proximal femur is commonplace in an older population and is a mainstay of treatment to promote early mobilization and weight-bearing. However, even with acute total hip arthroplasty for a geriatric acetabular fracture, most surgeons do not permit immediate weight-bearing postoperatively. Therefore, controversy regarding optimal treatment of these challenging fractures persists. Four treatment options have emerged: nonoperative treatment with early mobilization, open reduction and internal fixation (ORIF), limited open reduction and percutaneous screw fixation, and acute total hip arthroplasty. The exact indications and benefits of each treatment remain unknown. This article serves as a review of these four treatments and the data existing to support them.

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