Management of intraoperative acetabular fracture in primary total hip arthroplasty

Abstract Background: Intraoperative acetabular fracture（IAF）is a rare complication of primary total hip arthroplasty（THA）. The previous reports have lacked a sufficiently large number of subjects to allow for an analysis of the causes and appropriate treatment of this problem.Methods: Between 2015 to 2018, 4,888 primary THA were enrolled. We retrospectively reviewed the records in our Total Joint Registry Database and found that 24 patients (24 hips) had sustained intraoperative acetabular fractures. Twenty-four patients（16 females and 8males）were all treated with a posterolateral approach using uncemented components. Twenty patients（83.3%）underwent supplemental screw fixation, of which 2 patients were treated with steel plate fixation. Two patients’ femoral heads were used as a graft. In 4 patients（16.7%）, the acetabular components were judged to be stable despite the fracture and no additional treatment was performed. All patients were evaluated clinically with Harris Hip Scores (HHS) and radiographically with serial X-rays which follow up for a mean period of 34.0±12.6 months. We evaluated the anatomic locations, causes, treatments, and outcome of the fractures to study the treatment method and effect of intraoperative acetabular fracture during operation. Results: The fracture rate associated with uncemented components was 0.49%. In 17(70.8%) of these patients, the fracture was noted during the impaction of the real acetabular component. Six patients（25%）with Ankylosing Spondylitis had fractures, 4 in the anterior wall, and 1 in the anterior column, because the patient with hip joint fusion needs a to pre-osteotomy before the dislocation. The HHS score increased from 30.8±9.7 preoperatively to 90.2±4.2 postoperatively. All the latest x-ray showed that the fracture did not move, and there is no translucent line formed in the acetabular cup bone interface.Conclusion: Intraoperative acetabular fractures are rare complications of THA, and most commonly occur during the implantation of the acetabular components. It is necessary to prevent the occurrence of fractures as much as possible even if the fractures are found during the operation. It should be noted that patients with ankylosing spondylitis involving hip joints during THA surgery must be careful to prevent IAFs during dislocation and pre-osteotomy.

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Management of intraoperative acetabular fracture in primary total hip arthroplasty

10.21203/rs.3.rs-16473/v1 ◽

2020 ◽

Author(s):

Juncheng Li ◽

Quanbo Ji ◽

Ming Ni ◽

Qingyuan Zheng ◽

Jinyang Sun ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Acetabular Fracture ◽

Posterolateral Approach ◽

Fracture Rate ◽

X Rays ◽

Total Hip ◽

Primary Total Hip Arthroplasty

Abstract Background Intraoperative acetabular fracture(IAF)is a rare complication of primary total hip arthroplasty(THA). Previous report have locked a sufficiently large number of subjects to allow for an analysis of the causes and appropriate treatment of this problem. Methods Between 2015 to 2018, 4,888 primary THA were enrolled. We retrospectively reviewed the records in our Total Joint Registry Database and found that 24 patients (24 hips) had sustained IFAs .24 patients(16 females and 8males)were all treated with posterolateral approach using uncemented components. 20 patients underwent supplemental screw fixation, of which 2 patients were treated with plate fixation. 2 Patients femoral head was used as a graft. In 4 patients, the acetabular component was judged to be stable despite the fracture and no additional treatment was performed All patients were evaluated clinically with Harris Hip Scores (HHS) and radiographically with serial X-rays which follow up for a mean period of 34.0±12.6 months. We evaluated the anatomic location, cause, treatment, and outcome of the fractures. Results The fracture rate associated with uncemented components was 0.49%. In 17(70.8%) of the these patients, the fracture was noted during impaction of the real acetabular component.6 patients with Ankylosing Spondylitis had fracture 4 in anterior wall,1 in anterior column because of patient with hip joint fusion need to pre-osteotomy before dislocation .The HHS score increased from 30.8±9.7 preoperatively to 90.2±4.2 postoperatively. All the latest x-ray showed that the fracture did not move, and there is no translucent line formed in the acetabular cup bone interface.Conclusion IAFs are rare complications of THA, and most commonly occur during the implantation of the acetabular components. It is necessary to prevent the occurrence of fractures as much as possible even if the fractures are found during the operation. It should be noted that patients with ankylosing spondylitis involving hip joints during THA surgery must be careful to prevent IAFs during dislocation and pre-osteotomy.

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Primary Total Hip Arthroplasty After Acetabular Fracture*†

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200009000-00017 ◽

2000 ◽

Vol 82 (9) ◽

pp. 1328-1353 ◽

Cited By ~ 21

Author(s):

DANA C. MEARS ◽

JOHN H. VELYVIS

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Acetabular Fracture ◽

Total Hip ◽

Primary Total Hip Arthroplasty

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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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Pelvic Discontinuity Caused by Acetabular Overreaming during Primary Total Hip Arthroplasty

Case Reports in Orthopedics ◽

10.1155/2011/939202 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Iori Takigami ◽

Yoshiki Ito ◽

Takashi Mizoguchi ◽

Katsuji Shimizu

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Acetabular Fracture ◽

Rare Complication ◽

Acetabular Reconstruction ◽

Fibular Graft ◽

Intraoperative Complication ◽

Pelvic Discontinuity ◽

Total Hip ◽

Primary Total Hip Arthroplasty

Intraoperative acetabular fracture is a rare complication of primary total hip arthroplasty (THA), typically occurring during impaction of the cementless acetabular component. Here we report an unusual case of pelvic discontinuity caused by overreaming of the acetabulum during primary THA. Restoration of posterior columnar continuity was achieved with an autologous fibular graft and a reconstruction plate. Wall defects and cavitary defects were reconstructed with metal mesh and femoral head allograft, followed by placement and fixation of a Kerboull-type acetabular reinforcement device. Previous reports of acetabular fracture during THA have indicated that it has a relatively good prognosis without extensive treatment. However, to our knowledge, there has been no report of pelvic discontinuity necessitating acetabular reconstruction surgery as an intraoperative complication of primary THA.

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