Acute total hip arthroplasty for acetabular fractures in the elderly

2002 ◽  
Vol 73 (6) ◽  
pp. 615-618 ◽  
Author(s):  
Elyazid Mouhsine ◽  
Raffaele Garofalo ◽  
Olivier Borens ◽  
Jean-François Fischer ◽  
Xavier Crevoisier ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
The Elderly ◽  
Acetabular Fractures ◽  
Total Hip

scholarly journals Acetabular Fractures in the Elderly: Midterm Outcomes of Column Stabilisation and Primary Arthroplasty

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
A. Ortega-Briones ◽  
S. Smith ◽  
M. Rickman
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
The Elderly ◽  
Harris Hip Score ◽  
Acetabular Fractures ◽  
Management Decision ◽  
Total Hip ◽  
Articular Fractures ◽  
Primary Arthroplasty

Background. Interest in arthroplasty techniques for periarticular or intra-articular fractures in the elderly/osteoporotic patient continues to rise, including for geriatric acetabular fractures. In line with this, many acetabular fracture surgeons are now undertaking acute total hip arthroplasty in elderly/osteoporotic patients. Little is known however of the outcomes of this procedure, beyond the first year after surgery. Questions/Purposes. We determined the clinical outcomes of a series of elderly osteoporotic patients (mean age at surgery 77.4 years) treated for acetabular fractures with column fixation and simultaneous total hip arthroplasty, at a mean of 49 months after surgery. Methods. 24 patients (25 hips) were reviewed at a mean of 49 months after surgery. The surgical technique employed has previously been described. Radiographs were obtained, and clinical outcomes were assessed using Harris Hip Scores and the Merle d’Aubigné score. Results. 14 hips were available for assessment (9 deceased, 2 lost to follow-up). No patient suffered any complications beyond the perioperative period, no acetabular components were loose clinically or on latest radiographs, and the mean Harris Hip Score was 92. All but one patient scored good or excellent on the Merle d’Aubigné score. Conclusions. Column fixation and simultaneous total hip arthroplasty are a viable option for complex geriatric acetabular fractures, with encouraging midterm results. We conclude that THR is a viable long-term solution in this situation provided that the acetabular columns are stabilised prior to implantation, but more research is needed to aid in overall management decision making.

Acute Total Hip Arthroplasty in Acetabular Fractures in the Elderly Using the Octopus System

2013 ◽  
Vol 28 (6) ◽  
pp. 1005-1009 ◽  
Author(s):  
Rajesh Malhotra ◽  
Davinder Pal Singh ◽  
Vaibhav Jain ◽  
Vijay Kumar ◽  
Ravijot Singh
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
The Elderly ◽  
Acetabular Fractures ◽  
Total Hip

Acute total hip arthroplasty combined with internal fixation for displaced acetabular fractures in the elderly

2019 ◽  
Vol 101-B (4) ◽  
pp. 478-483 ◽  
Author(s):  
T. Borg ◽  
B. Hernefalk ◽  
N. P. Hailer
Keyword(s):  
Total Hip Arthroplasty ◽  
Internal Fixation ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Patient Reported Outcomes ◽  
Patient Survival ◽  
The Elderly ◽  
Acetabular Fractures ◽  
Total Hip ◽  
Patient Reported

Aims Displaced, comminuted acetabular fractures in the elderly are increasingly common, but there is no consensus on whether they should be treated non-surgically, surgically with open reduction and internal fixation (ORIF), or with acute total hip arthroplasty (THA). A combination of ORIF and acute THA, an approach called ’combined hip procedure’ (CHP), has been advocated and our aim was to compare the outcome after CHP or ORIF alone. Patients and Methods A total of 27 patients with similar acetabular fractures (severe acetabular impaction with or without concomitant femoral head injury) with a mean age of 72.2 years (50 to 89) were prospectively followed for a minimum of two years. In all, 14 were treated with ORIF alone and 13 were treated with a CHP. Hip joint and patient survival were estimated. Operating times, blood loss, radiological outcomes, and patient-reported outcomes were assessed. Results No patient in the CHP group required further hip surgery, giving THA a survival rate of 100% (95% confidence interval (CI) 100 to 100) after three years, compared with 28.6% hip joint survival in the ORIF group (95% CI 12.5 to 65.4; p = 0.001). No dislocations or deep infections occurred in the CHP group. No patient died within the first year after index surgery, but patient survival was lower in the CHP group after three years. There were no relevant differences in patient-reported outcomes. Conclusion The CHP confers a considerably reduced need of further surgery when compared with ORIF alone in elderly patients with complex acetabular fractures. These findings encourage both further use of, and larger prospective studies on, the CHP. Cite this article: Bone Joint J 2019;101-B:478–483.

scholarly journals The influence of bone quality on radiological outcome in 50 consecutive acetabular fractures treated with a pre-contoured anatomic suprapectineal plate

2021 ◽  
Author(s):  
Maximilian J. Hartel ◽  
Tareq Naji ◽  
Florian Fensky ◽  
Frank O. Henes ◽  
Darius M. Thiesen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Mass ◽  
Bone Quality ◽  
Hip Arthroplasty ◽  
Mass Density ◽  
Acetabular Fractures ◽  
Bone Mass Density ◽  
Radiological Outcome ◽  
Total Hip ◽  
The Impact

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.

Biomechanical analysis of transverse acetabular fracture fixation in the elderly via the posterior versus the anterior approach with and without a total hip arthroplasty

2020 ◽  
Vol 234 (9) ◽  
pp. 966-974
Author(s):  
Joel Moktar ◽  
Alan Machin ◽  
Habiba Bougherara ◽  
Emil H Schemitsch ◽  
Radovan Zdero
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Acetabular Fracture ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Failure Load ◽  
The Elderly ◽  
Clinical Failure ◽  
Total Hip

This study provides the first biomechanical comparison of the fixation constructs that can be created to treat transverse acetabular fractures when using the “gold-standard” posterior versus the anterior approach with and without a total hip arthroplasty in the elderly. Synthetic hemipelvises partially simulating osteoporosis (n = 24) were osteotomized to create a transverse acetabular fracture and then repaired using plates/screws, lag screws, and total hip arthroplasty acetabular components in one of four ways: posterior approach (n = 6), posterior approach plus a total hip arthroplasty acetabular component (n = 6), anterior approach (n = 6), and anterior approach plus a total hip arthroplasty acetabular component (n = 6). All specimens were biomechanically tested. No differences existed between groups for stiffness (range, 324.6–387.3 N/mm, p = 0.629), clinical failure load at 5 mm of femoral head displacement (range, 1630.1–2203.9 N, p = 0.072), or interfragmentary gapping (range, 0.67–1.33 mm, p = 0.359). Adding a total hip arthroplasty acetabular component increased ultimate mechanical failure load for posterior (2904.4 vs. 3652.3 N, p = 0.005) and anterior (3204.9 vs. 4396.0 N, p = 0.000) approaches. Adding a total hip arthroplasty acetabular component also substantially reduced interfragmentary sliding for posterior (3.08 vs. 0.50 mm, p = 0.002) and anterior (2.17 vs. 0.29 mm, p = 0.024) approaches. Consequently, the anterior approach with a total hip arthroplasty may provide the best biomechanical stability for elderly patients, since this fixation group had the highest mechanical failure load and least interfragmentary sliding, while providing equivalent stiffness, clinical failure load, and gapping compared to other surgical options.

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