Abstract
Severe acetabular fractures are difficult to treat. Complications include blood loss, neural damage, long operating times, and a high risk of sepsis and failure. Even when the fracture is ideally stabilised, there is a major risk of secondary osteoarthritis. This can be related to bone necrosis, cartilage surface damage, bone loss.
However, even in young patients modern surgical techniques, including use of an alumina-against-alumina bearing, may facilitate long-term survival without limitation of activity.
Functionally, the results of secondary procedures after failed osteosynthesis are statistically worse than after primary total hip arthroplasty (THA). The surgery is difficult because of material retrieval difficulties, nerve dissection, bone reconstruction and remaining muscular dysfunction.
We reviewed the results of 80 THA procedures done between 1980 and 1998 to treat 58 acetabular fractures. The mean age of our 57 patients (39 men and 18 women) was 50 years (21 to 80). The mean delay between fracture and THA was 10 years in 22 patients who had undergone osteosynthesis and six years in 35 patients who had been treated conservatively. The mean follow-up period was 5,5 years (6 months to 20 years).
There were eight instances of socket loosening, two of which were septic and six aseptic. Two of these patients had screw-in prostheses and six had cemented. There were 19 sciatic palsies, 13 of which developed after trauma, four after osteosynthesis and two after THA. There were three cases of gluteus medius palsy. In two of four cases of sepsis that occurred after osteosynthesis, sepsis recurred after THA, and in one patient sepsis developed after THA.
In this limited series, patients who underwent THA after osteosynthesis did not have as good an outcome as those in whom initial orthopaedic treatment was followed some weeks later by THA. We believe many poor results could have been avoided with better primary surgery. Functional results are likely to be better, and the incidence of complications lower, if primary THA is performed in conjunction with acetabular reconstruction. Of course, for treatment of simple acetabular fracture involving major displacement of the posterior wall, one column osteosynthesis is still recommended.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at The Department of Orthopaedic Surgery, Medical School, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
