The increasing prevalence of osteoporosis in
an ageing population has contributed to older patients becoming
the fastest-growing group presenting with acetabular fractures.
We performed a systematic review of the literature involving a number
of databases to identify studies that included the treatment outcome
of acetabular fractures in patients aged >
55 years. An initial
search identified 61 studies; after exclusion by two independent
reviewers, 15 studies were considered to meet the inclusion criteria.
All were case series. The mean Coleman score for methodological
quality assessment was 37 (25 to 49). There were 415 fractures in
414 patients. Pooled analysis revealed a mean age of 71.8 years
(55 to 96) and a mean follow-up of 47.3 months (1 to 210). In seven
studies the results of open reduction and internal fixation (ORIF)
were presented: this was combined with simultaneous hip replacement
(THR) in four, and one study had a mixture of these strategies.
The results of percutaneous fixation were presented in two studies,
and a single study revealed the results of non-operative treatment. With fixation of the fracture, the overall mean rate of conversion
to THR was 23.1% (0% to 45.5%). The mean rate of non-fatal complications
was 39.8% (0% to 64%), and the mean mortality rate was 19.1% (5%
to 50%) at a mean of 64 months (95% confidence interval 59.4 to
68.6; range 12 to 143). Further data dealing with the classification
of the fracture, the surgical approach used, operative time, blood
loss, functional and radiological outcomes were also analysed. This study highlights that, of the many forms of treatment available
for this group of patients, there is a trend to higher complication
rates and the need for further surgery compared with the results
of the treatment of acetabular fractures in younger patients. Cite this article:
The purpose of this study was to establish whether
exploration and neurolysis is an effective method of treating neuropathic
pain in patients with a sciatic nerve palsy after total hip replacement
(THR). A total of 56 patients who had undergone this surgery at
our hospital between September 1999 and September 2010 were retrospectively identified.
There were 42 women and 14 men with a mean age at exploration of
61.2 years (28 to 80). The sciatic nerve palsy had been sustained
by 46 of the patients during a primary THR, five during a revision
THR and five patients during hip resurfacing. The mean pre-operative
visual analogue scale (VAS) pain score was 7.59 (2 to 10), the mean
post-operative VAS was 3.77 (0 to 10), with a resulting mean improvement
of 3.82 (0 to 10). The pre- and post-neurolysis VAS scores were
significantly different (p <
0.001). Based on the findings of
our study, we recommend this form of surgery over conservative management
in patients with neuropathic pain associated with a sciatic nerve
palsy after THR. Cite this article:
