Abstract
The purpose of this study was to review the clinical and radiographic outcome in THRs done following acetabular fractures (fx). All patients undergoing conversion THR after previous acetabular fx between 1990 and 2006 at a single institution were identified.
Clinical evaluation was done using the Harris hip scale. Radiographic evaluation was done using the system proposed by the Hip society. THRs as part of initial treatment for acute acetabular fx were excluded.
There were 90 THRs (90 patients) performed in patients previously treated for an acetabular fracture. At the time of their acetabular facture, 67 had been treated with ORIF, 12 were treated with closed or limited open reduction and percutaneous fixation, and 11 were treated without surgery. The mean age at injury was 43.7 years, (range, 14–79). 68 patients sustained their fx from a high-energy mechanism (MVC, MPC, or MCC).
Three patterns accounted for 52% of the fx: transverse posterior wall (20), both column (18), and T-Type (9). Associated pelvic fractures were present in 14 patients. Associated ipsilateral proximal femur fractures were present: femoral head (four), femoral neck (five), and femoral shaft (three). Among those treated with ORIF, marginal impaction was noted in 31 and osteo-chondral head damage in 32 hips.
The mean interval between injury and THR was 42 months (range, two months to 32 years). Cement-less fixation was used in 81 of the 90 cups. Similarly, cementless stems were used in 80 stems. Bone graft was necessary in 26 patients (17 autograft, nine allograft). Two cases each required pelvic augments and reinforcement cage, respectively.
Additional findings at THR included: femoral head erosion (53 hips), femoral head osteonecrosis (37 hips), osteonecrosis of the acetabulum (22 hips), and fx non-union (six hips). The average cup abduction angle was 440 (range, 28 to 60), the average cup height was 24 mm (range, 10 to 42), and the average medialization distance was 23 mm (range, 5 to 48). The mean EBL was 810 ml and mean operative time was 195 minutes. The mean F/U was 36 months (range, 6 months to 17 years). The median Harris hip score was 89 at the most recent F/U. Fifteen revisions (16%) have been done: aseptic loosening (seven hips), recurrent dislocation (six hips) and infection (two hips).
Five of the six revisions for recurrent dislocation were performed in patients who had a posterior approach for both their acetabular fracture treatment and their THR. No revision was done in those who had been initially with percutaneous fixation. There was no infection in those who had been initially with percutaneous fixation either from the fx treatment or the THR. In contrast, 14 ORIF patients were complicated by infection. One of these developed infection following THR.
Our data support the clinical efficacy and mid-term durability of THR in this patient group. Aseptic loosening and recurrent dislocation remain the primary reasons for revision surgery.
Correspondence should be addressed to Diane Przepiorski at ISTA, PO Box 6564, Auburn, CA 95604, USA. Phone: +1 916-454-9884; Fax: +1 916-454-9882; E-mail: ista@pacbell.net
