Konigsberg*, Nordin, Lackner, Hartman and Garvin

University of Nebraska Medical Center, Nebraska Medical Center, USA

*Corresponding Author: Konigsberg, University of Nebraska Medical Center, Nebraska Medical Center, USA.

Received: December 31, 2021; Published: January 25, 2022

Abstract

Background: Acetabulum fractures can lead to post-traumatic arthritis necessitating total hip arthroplasty (THA). Some studies have shown higher rates of failure in patients undergoing THA after acetabular fracture as compared to primary THA. Likewise, studies have shown uncemented acetabular fixation has shown improved outcomes in primary THA.

Study Objective: This study evaluates outcomes of uncemented acetabular fixation in THA for post-traumatic arthritis following an acetabular fracture. Furthermore, there are comparisons of outcomes between highly cross-linked polyethylene (HXLPE) with conventional polyethylene as well as evaluation of outcomes utilizing different femoral head components.

Methods: 78 total hip arthroplasties (77 patients) for post-traumatic arthritis after acetabulum fracture were performed at our institution from 1991-2015. Routine follow-up was performed (range 6 weeks to 23 years). After institutional review board approval, patients were asked to return for clinical and radiographic evaluation. Patients who were unable to return to clinic were contacted by mail and telephone. At the time of this study, twenty-three patients were known to have died. Fifty-eight patients (59 hips) had a minimum of 2 year follow up available.

Results: Of the 78 arthroplasties performed, 8 (10.2%) underwent revision surgery (3 for instability, 1 for loosening, 1 for wear and trunnionosis, 1 for femoral fracture, 1 for infection, and 1 for persistent pain).

Of the 58 patients with a minimum of 2-year follow-up available, the mean follow-up period was 10.2 years (2-25). 6 of the 59 (10.2%) arthroplasties has been revised. The mean Harris Hip Score was 79.6 (33-100). There were 50 HXLPE liners, 8 conventional polyethylene and 1 ceramic liner. These showed no clinical or radiographic difference at any follow up period. There was 1 revision for polyethylene wear at 16 years postoperatively in a patient with a conventional liner.

Conclusion: The intermediate term results of a relatively large group of patients who underwent cementless THA for post-traumatic arthritis following acetabular fracture at a single institution over a 24-year period yielded satisfactory outcomes with revision rates comparable or better to other similar studies. Additionally, there were no differences in revision rates seen with conventional polyethylene vs HXPLE. Femoral head implant bearing surface also did not have an observable difference in outcomes.

Keywords: Acetabulum Fracture; Hip Arthroplasties; Posttraumatic Arthritis

References

1. Matta JM. “Fracture of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury”. Orthopedic Trauma Directions2 (2011): 31-36.
2. Mayo KA. “Open reduction and internal fixation of fractures of the acetabulum. results in 163 fractures”. Clinical Orthopaedics and Related Research 305 (1994): 31-37.
3. Letournel E. “Acetabulum fractures: Classification and management”. Orthopedic Trauma Directions5 (2007): 27-33.
4. Pennal GF., et al. “Results of treatment of acetabular fractures”. Clinical Orthopaedics and Related Research 151 (1980): 115-123.
5. Ragnarsson B and Mjöberg B. “Arthrosis after surgically treated acetabular fractures: A retrospective study of 60 cases”. Acta Orthopaedica Scandinavica 5 (1992): 511-514.
6. Frietman B., et al. “Patient-reported outcome measures after surgery for an acetabular fracture”. Bone Joint Journal5 (2018): 640-645.
7. Jimenez ML., et al. “Total hip replacement after acetabular fracture”. Orthopedic Clinics3 (1997): 435-446.
8. Bellabarba C., et al. “Cementless acetabular reconstruction after acetabular fracture”. Journal of Bone and Joint Surgery 6 (2001): 868-876.
9. Malkin C and Tauber C. “Total hip arthroplasty and acetabular bone grafting for unreduced fracture-dislocation of the hip”. Clinical Orthopaedics and Related Research 1985 (201): 57-59.
10. Rogan IM., et al. “Total hip-replacement following fracture dislocation of the acetabulum” 61.2 (1979): 252.
11. Romness DW and Lewallen DG. “Total hip arthroplasty after fracture of the acetabulum. long-term results”. The Journal of Bone and Joint Surgery. British Volume5 (1990): 761-764.
12. Berry DJ and Halasy M. “Uncemented acetabular components for arthritis after acetabular fracture”. Clinical Orthopaedics and Related Research® 405 (2002): 164-167.
13. Berger RA., et al. “Hybrid total hip arthroplasty: 7-to 10-year results”. Clinical Orthopaedics and Related Research 333 (1996): 134-146.
14. Mohler CG., et al. “Total hip replacement with insertion of an acetabular component without cement and a femoral component with cement. four to seven-year results”. The Journal of Bone and Joint Surgery. American Volume 1 (1995): 86-96.
15. Huo MH., et al. “Total hip replacements done without cement after acetabular fractures: A 4-to 8-year follow-up study”. Journal of Arthroplasty7 (1999): 827-831.
16. Ranawat A., et al. “Total hip arthroplasty for posttraumatic arthritis after acetabular fracture”. Journal of Arthroplasty 5 (2009): 759-767.
17. Von Roth P., et al. “Total hip arthroplasty after operatively treated acetabular fracture: A concise follow-up, at a mean of twenty years, of a previous report”. Journal of Bone and Joint Surgery4 (2015): 288-291.
18. Morison Z., et al. “Total hip arthroplasty after acetabular fracture is associated with lower survivorship and more complications”. Clinical Orthopaedics and Related Research®2 (2016): 392-398.
19. Wang T., et al. “Delayed total hip arthroplasty after failed treatment of acetabular fractures: An 8-to 17-year follow-up study”. Journal of Orthopaedic Surgery and Research1 (2018): 1-7.
20. Surace MF., et al. “Conventional versus cross-linked polyethylene for total hip arthroplasty”. Orthopedics 9 (2015): 556-561.
21. Jassim SS., et al. “Five-year comparison of wear using oxidised zirconium and cobalt–chrome femoral heads in total hip arthroplasty: A multicentre randomised controlled trial”. The Bone and Joint Journal7 (2015): 883-889.
22. Weber M., et al. “Total hip arthroplasty after operative treatment of an acetabular fracture”. Journal of Bone and Joint Surgery9 (1998): 1295-1305.

Citation

Citation: Konigsberg., et al. “Intermediate Term Results of Total Hip Arthroplasty with Uncemented Acetabular Components for Patients with a Prior Acetabular Fracture".Acta Scientific Orthopaedics 5.2 (2022): 20-24.

Copyright

Copyright: © 2022 Konigsberg., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.