Deep infection after acetabular fracture surgery is a serious complication, ranging between 1.2% and 2.5% and has been a challenge for patients and surgeons. It increases length of hospital stay by three to four times due to the need of extra surgeries for debridement, impairs future patient's mobility, and increases the overall costs of care. Aim: We aim to identify pre- and intra-operative risk factors associated with deep infections in surgically treated acetabular fractures.

Methods: In a single-center retrospective case-control study, 447 consecutive patients who underwent open reduction and internal fixation of acetabular fractures were included in the study. Diagnosis of surgical site infections required a combination of clinical signs and positive tissue culture or histological signs of tissue infection according to Lipsky et al (2010) and Fleischer et al (2009). To evaluate risk factors from SSI we performed uni- and multivariate analysis by multiple logistic regression.

Results: Among 447 patients studied, 23 (5.1%) presented diagnosis of postoperative infection. 349 (78.1%) were male with a mean age of 33.3 years old. Posterior wall fractures accounted for 119 cases (26.6%) followed by 102 (22.8%) double column fractures and 57 (12.8%) T fractures. Factors associated with a significantly risk of infection were patient-related: older age and alcoholism (OR = 5.15, 95% CI = 1.06 to 21.98; p=0.036); trauma-related: fractures of the lower limb (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.8 to 6.78; p=0.017), comminution (OR = 3.6, 95% CI = 1.19 to 8.09; p=0.009), pelvic ring injuries (OR = 2.89, 95% CI = 1.07 to 7.63; p=0.037); and surgical-related: peri- operative complications (OR = 5.12, 95% CI = 1.85 to 13.8; p=0.001), and dislocation (OR = 0.21, 95% CI = 0.03 to 0.96; p=0.023). Duration of surgery longer than 300 min (p=0.002), and type of surgical approach (p<0.001) were also associated with infection.

Conclusion: Deep infections after acetabular fracture surgery were mainly associated with prolonged duration of surgery and the interrelation with the complexity of the fracture such as double column fractures, combined surgical approach, comminution and intra operative complications. Pelvic ring injuries, lower limb fractures, mean age, no dislocations at the time of accident and alcoholism is others associations.

Introduction

One of the most common complications of ceramic on ceramic hip replacement is squeaking. The association of Accolade stem and Trident acetabular system has been reported to have squeaking incidence of up to 35,6%. There is doubt if this phenomenon occurs due to: the stem titanium alloy, the V40 femoral neck, the recessed liner of the trident cup or even the mal-seating of the trident insert on the cup.

One of major problems in Total Hip Arthroplasty is thigh pain. We have examined the effect of femoral canal injection of Calcium Phosphate Paste (CPP) for cementless THA. CPP is a mixture of alpha Tri-Calcium Phosphate, Tetra-Calcium Phosphate, Calcium Hydrogen Phosphate and Hydroxyapatite. This paste harden in 10 minutes and its stiffness increases to 80Mpa in 3days.

Cementless THA were performed in 45 osteoarthritic hips from 1999 to 2002. Eight of 40 patients were male and 32 were female, average age were 62.4 years old ranged 43 to 81. In 11 hips, CPP (10–12g) were filled as a femoral canal filler around the distal end of stem. In 34 hips, as a control, no CPP were filled in the canal. Proximal part of the stem was HA coated on rough metal surface.

No thigh pain were observed in CPP group patients. In control group, five hips (14.7%) showed thigh pain (p< 0.05), but walking disability and pain were mild in the first year and improved by the next year. CPP filled in the canal were absorbed slowly on X-ray film, but prevention of thigh pain lasts for long time maximum 3 years. No infections and pulmonary embolism were observed in both series.

Filling CPP into the gap between stem tip and femoral canal is useful technique to prevent thigh pain after cementless THA.

Prevention of joint dislocation after total hip arthroplasty (THA) is important to keep suitable relationships between surgeons and patients. Capsule has an essential role for stability of joint, especially in hip. Reserving a part of capsule in THA can increase stability. We examined the effect of partial capsulotomy in hip joint for prevention of dislocations after THA.

In 178 primary THA for osteoarthritis, partial capsulotomy were performed in 92 cases and generous capsulectomy in 86 cases from 1993 to 2001. Age, gender, pre-operative complications of both groups were matched. All THA were performed from a posterior approach, and in case of partial capsulotomy, anterior one third of hip joint capsule was reserved before placing acetabular component. Posterior capsulorrhaphy was not performed.

No hip dislocations have been seen in partial capsulotomy cases, and four posterior dislocations following THA were observed in general capsulectomy cases during one to nine year follow up.

Soft tissue imbalance of THA is most at risk for dislocation. The present study showed a satisfying result of partial capsulotomy for prevention of THA dislocation. Residual hip joint capsule can increase joint stability and can resist to dislocation after THA in osteoarthritis.