CEMENTED TOTAL HIP ARTHROPLASTY FOR ACETABULAR FRACTURE: RESULTS AT MINIMUM 5 YEARS FOLLOW-UP

Abstract

Purpose: The purpose of this retrospective study was to evaluate at minimal 5 years follow-up outcome in a consecutive series of total hip arthroplasties implanted for fracture of the acetabulum.

Material and methods: The series included 53 arthroplasties implanted between January 1980 and December 1995 in 53 patients, 16 women and 37 men, mean age 53.1 years (24–84). The initial fracture involved the acetabular wall in 18 patients, one column in seven and two columns in six. It was a complex fracture in eleven cases and classification was unknown in the eleven other hips. Orthopaedic treatment was used for 23 patients and surgery for 30. Mean time between fracture and arthroplasty was 16.4±10.8 years. Cemented Charnley-Kerboull implants with a metal-polyethylene bearing were used. The Postel-Merle-d’Aubigné (PMA) score was used to assess functional outcome. The actuarial survival was determined.

Results: At five years minimum follow-up, 33 patients were alive and had not undergone revision at mean follow-up of 12.4±3.8 years (7–21). Six patients had had revision of the acetabular and/or femoral element, five patients had died, and seven were lost to follow-up. Revisions were required for cup wear associated with periacetabular osteolysis. The mean preoperative functional score was 10.6±2.5 versus 16.2±2.8 (8–18) at last follow-up (Wilcoxon rank test, p< 0.0001). Cumulative survival, taking revision as failure, was 90.3±6.5% at 15 years (95%CI 77.6–100%) for hips treated orthopaedically versus 66.5±14.5 (95%CI 38.1–94.9%) for hips treated surgically. The difference for the analyzable hips was not significant (logrank, p=0.69).

Discussion: The results of this series confirm that the long-term risk of mechanical failure of total hip arthroplasty for fracture of the acetabulum is high.