Purpose: The purpose of this study was to assess outcome after first-intention total hip arthroplasty for fresh fractures of the acetabulum in elderly patients.

Material and methods: We present a retrospective analysis of 18 recent fractures of the acetabulum observed in nine men and nine women, mean age 74.8 years which were treated by first-intention total hip arthroplasty. The fractures were considered equivalent to acetabular bone deficits observed at revision of total arthroplasty (five grade III, 13 grade IV in the SOFCT 1988 classification).

The prosthesis was implanted 15.6 days (mean) after initial trauma and included a metal-backed acetabular implant (except one case) and a bone autograft (except three cases). Complete weight bearing was authorised on day 3 postop for five patients, and at six weeks for ten; at three months for the other three.

Mean follow-up was 2.5 years. Thirteen surviving patients were reviewed clinically and radiographically. Five patients who had died were also included in the analysis using data reported by family before death.

The Postel-Merle d’Aubigné (PMA) and Harris scores were recorded. Survival curves were plotted. Radiological assessment included bone healing, status of the prosthetic assembly, presence of a lucent line or signs of loosening in the three acetabular zones described by De Lee and Charnley.

Results: The mean functional scores were 13.6/18 (PMA) and 71.8/100 (Harris). There were no cases of infection or dislocation. Median Kaplan-Meier survival was six years. The one-year survival rate was 94.4%. Five deaths were recorded, all due to causes independent of the surgical intervention.

Radiologically, all fractures had healed. There were no mechanical complications and no signs of acetabular loosening.

Discussion: Several authors have demonstrated that prognosis is poor in elderly subjects undergoing surgical osteosynthesis or functional treatment due to the presence of risk factors (osteoporosis, comminution, deferred surgery due to poor general status). Prolonged bed rest may also have life-threatening consequences. Other work has emphasised the very high rate of complications after revision surgery for dismounted material, post-traumatic deterioration, or osteonecrosis.

The absence of early deaths and the low rate of intervention-related morbidity in this series of elderly patients is in agreement with a very small number of publications devoted to this topic.

Conclusion: This therapeutic attitude enables early verticalisation avoiding the complications related to the bedridden state in the elderly. In addition, subsequent revision for osteonecrosis of the femoral head or post-traumatic deterioration can be avoided. These results have incited us to pursue this therapeutic option.

Purpose: We report a retrospective series of 28 patients with trauma-induced dislocation of the knee. The purpose of our study was to evaluated long-term outcome after orthopaedic as well as surgical management of these injured knees and to propose a therapeutic attitude best adapted to the initial situation.

Material and methods: The series included 28 patients, including one who had a bilateral dislocation. There were four women and 24 men, mean age 35.3 years at the time of the accident (17–69). Mean follow-up was 10.8 years. Nineteen knees were treated orthopaedically after reduction, surgery was used for ten patients. Five patients underwent an initial operation (during the first week following the accident), five had a secondary operation one to eight years after the accident. Mobility and laxity were assessed clinically. The Lysholm-Tegner and the Meyers scores were used to assess function. Radiological results were assessed with the Ahlback classification and the IKDC score to judge potential progression to single-or triple compartment osteoarthritis.

Results: Clinically, mean amplitude was 105° flexion and −2° extension. Four knees were stiff with flexion = 80°. There was a persistent anterior drawer sign for all knees except four. Medial laxity (valgus) was often important (83% of the patients). Functionally, the mean Lysholm score was 80.5 (17–100). The mean pre and post-trauma Tegner score was 5.1/3. The Meyes classification showed 15 good and excellent results and eight fair and six poor results. Radiographically, more than half the patients had no sign of degenerative joint disease and only four knees has signs of true three-compartment osteoarthritis according to the Ahlback classification. Separate analysis of patients treated orthopaedically and surgically showed that good results with orthopaedic treatment concerned patients with an anterior or posterior dislocation with predominantly anterior laxity. The fair and poor results concerned six of the eight patients with initially multidimensional laxity, particularly postero-lateral laxity that persisted at last follow-up. Surgical treatment gave good results mainly when given early (four very good results out of five knees).

Discussion: Recent work has demonstrated very satisfactory results for femorotibal stability after ligament reconstruction, usually with allografts. Our good functional results, comparable with earlier series, and the encouraging radiographic results have led us to chose orthopaedic treatment for selected patients (correct preservation of the posterolateral plane, particularly in case of dislocation with hyperextension corresponding to grade II in the Schenck classification), and on the contrary, to prefer early surgical treatment for the posterolateral plane.

Conclusion: Management of injury to knee ligaments after femorotibial dislocations should be guided by a precise examination of the initial laxities conducted under general anaesthesia. If the posteriolateral plane is satisfactory, orthopaedic treatment followed by active rehabilitation can provide good functional and radiographic results.