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A Review of Total Hip Replacement Following Acetabular Fractures

  • Geriatric Orthopedics (E Meinberg, Section Editor)
  • Published:
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Abstract

Purpose of Review

The incidence of geriatric acetabular fractures is increasing with our aging population. Geriatric acetabular fractures offer unique challenges to treating physicians due to the complexity of fracture patterns, osteoporotic bone, and pre-existing joint arthritis. Controversy remains regarding the optimal reconstructive treatment of these injuries, and both acute and delayed total hip arthroplasty options exist in appropriate settings for these patients.

Recent Findings

While early experience with acute THA led to poor clinical outcomes, several newer studies report improvements in survivorship and in clinical outcomes (HHS scores ranging from 87-93). Cementless acetabular components and porous metal cups show improved outcomes and survival rates (87–88% in short-midterm follow up) in delayed THA.

Summary

In our review of recent literature within the past 5 years, we have found that modern surgical techniques and improvements in cementless acetabular fixation show promising results and improved clinical and radiographic outcomes for the treatment of acetabular fractures in older patients.

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References

  1. Mears DC. Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone. The Journal of the American Academy of Orthopaedic Surgeons. 1999;7(2):128–41.

    Article  CAS  PubMed  Google Scholar 

  2. Gary JL, Paryavi E, Gibbons SD, Weaver MJ, Morgan JH, Ryan SP, et al. Effect of surgical treatment on mortality after acetabular fracture in the elderly: a multicenter study of 454 patients. J Orthop Trauma. 2015;29(4):202–8.

    Article  PubMed  Google Scholar 

  3. Morison Z, Moojen DJ, Nauth A, Hall J, McKee MD, Waddell JP, et al. Total hip arthroplasty after acetabular fracture is associated with lower survivorship and more complications. Clin Orthop Relat Res. 2016;474(2):392–8.

    Article  PubMed  Google Scholar 

  4. Daurka JS, Pastides PS, Lewis A, Rickman M, Bircher MD. Acetabular fractures in patients aged >55 years: a systematic review of the literature. The bone & joint journal. 2014;96-B(2):157–63.

    Article  CAS  Google Scholar 

  5. Ferguson TA, Patel R, Bhandari M, Matta JM. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. The Journal of bone and joint surgery British volume. 2010;92(2):250–7.

    Article  CAS  PubMed  Google Scholar 

  6. •• O’Toole RV, Hui E, Chandra A, Nascone JW. How often does open reduction and internal fixation of geriatric acetabular fractures lead to hip arthroplasty? J Orthop Trauma. 2014;28(3):148–53. This retrospective review of 147 patients shows a high rate of moratily and conversion to total hip arthroplasty after open reduction and internal fixation of acetabular fractures in patients over the age of 60.

    Article  PubMed  Google Scholar 

  7. Weber M, Berry DJ, Harmsen WS. Total hip arthroplasty after operative treatment of an acetabular fracture. J Bone Joint Surg Am. 1998;80(9):1295–305.

    Article  CAS  PubMed  Google Scholar 

  8. Moed BR, WillsonCarr SE, Watson JT. Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Joint Surg Am. 2002;84-A(5):752–8.

    Article  PubMed  Google Scholar 

  9. Borg T, Hailer NP. Outcome 5 years after surgical treatment of acetabular fractures: a prospective clinical and radiographic follow-up of 101 patients. Arch Orthop Trauma Surg. 2015;135(2):227–33.

    Article  PubMed  Google Scholar 

  10. • Salama W, Mousa S, Khalefa A, Sleem A, Kenawey M, Ravera L, et al. Simultaneous open reduction and internal fixation and total hip arthroplasty for the treatment of osteoporotic acetabular fractures. Int Orthop. 2017;41(1):181–9. This report shows outcomes of acute combined fixation and total hip replacement using modern techniques.

    Article  PubMed  Google Scholar 

  11. Tannast M, Najibi S, Matta JM. Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg Am. 2012;94(17):1559–67.

    Article  PubMed  Google Scholar 

  12. Boelch SP, Jordan MC, Meffert RH, Jansen H. Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures: a retrospective clinical study. Int. Orthop. 2016.

  13. Chiu FY, Lin YP, Hung SH, Su YP, Liu CL. Cementless acetabular reconstruction for Arthropathy in old acetabular fractures. Orthopedics. 2015;38(10):e934–9.

    Article  PubMed  Google Scholar 

  14. Hayes PJ, Carroll CM, Roberts CS, Seligson D, Lau E, Kurtz S, et al. Operative treatment of acetabular fractures in the Medicare population. Orthopedics. 2013;36(8):e1065–70.

    Article  PubMed  Google Scholar 

  15. Ochs BG, Marintschev I, Hoyer H, Rolauffs B, Culemann U, Pohlemann T, et al. Changes in the treatment of acetabular fractures over 15 years: analysis of 1266 cases treated by the German pelvic multicentre study group (DAO/DGU). Injury. 2010;41(8):839–51.

    Article  PubMed  Google Scholar 

  16. Kim JW, Herbert B, Hao J, Min W, Ziran BH, Mauffrey C. Acetabular fractures in elderly patients: a comparative study of low-energy versus high-energy injuries. Int Orthop. 2015;39(6):1175–9.

    Article  PubMed  Google Scholar 

  17. Mauffrey C, Hao J, Cuellar 3rd DO, Herbert B, Chen X, Liu B, et al. The epidemiology and injury patterns of acetabular fractures: are the USA and China comparable? Clin Orthop Relat Res. 2014;472(11):3332–7.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Schnaser E, Scarcella NR, Vallier HA. Acetabular fractures converted to total hip arthroplasties in the elderly: how does function compare to primary total hip arthroplasty? J Orthop Trauma. 2014;28(12):694–9. The clinical outcomes of delayed THA are still inferior to primary THA cohort

    Article  PubMed  Google Scholar 

  19. •• Butterwick D, Papp S, Gofton W, Liew A, Beaule PE. Acetabular fractures in the elderly: evaluation and management. J Bone Joint Surg Am. 2015;97(9):758–68. This is an excellent review of geriatric acetabular fracture management.

    Article  PubMed  Google Scholar 

  20. von Roth P, Abdel MP, Harmsen WS, Berry DJ. Total hip arthroplasty after operatively treated acetabular fracture: a concise follow-up, at a mean of twenty years, of a previous report. J Bone Joint Surg Am. 2015;97(4):288–91.

    Article  Google Scholar 

  21. Yuan BJ, Lewallen DG, Hanssen AD. Porous metal acetabular components have a low rate of mechanical failure in THA after operatively treated acetabular fracture. Clin Orthop Relat Res. 2015;473(2):536–42.

    Article  PubMed  Google Scholar 

  22. Huo MH, Solberg BD, Zatorski LE, Keggi KJ. Total hip replacements done without cement after acetabular fractures: a 4- to 8-year follow-up study. J Arthroplast. 1999;14(7):827–31.

    Article  CAS  Google Scholar 

  23. Letournel E. Surgical treatment of acetabular fractures. The Hip. 1987:157–80.

  24. Letournel E. Results of surgical treatment of acetabular fractures. Acta Orthop Belg. 1984;50(3):423–33.

    CAS  PubMed  Google Scholar 

  25. Letournel E. The treatment of acetabular fractures through the ilioinguinal approach. Clin Orthop Relat Res. 1993;292:62–76.

    Google Scholar 

  26. Makridis KG, Obakponovwe O, Bobak P, Giannoudis PV. Total hip arthroplasty after acetabular fracture: incidence of complications, reoperation rates and functional outcomes: evidence today. J Arthroplast. 2014;29(10):1983–90.

    Article  Google Scholar 

  27. Spencer RF. Acetabular fractures in older patients. The Journal of bone and joint surgery British volume. 1989;71(5):774–6.

    CAS  PubMed  Google Scholar 

  28. Sen RK, Veerappa LA. Long-term outcome of conservatively managed displaced acetabular fractures. J Trauma. 2009;67(1):155–9.

    Article  PubMed  Google Scholar 

  29. Gansslen A, Hildebrand F, Krettek C. Conservative treatment of acetabular both column fractures: does the concept of secondary congruence work? Acta Chir Orthop Traumatol Cechoslov. 2012;79(5):411–5.

    CAS  Google Scholar 

  30. Helfet DL, Borrelli Jr J, DiPasquale T, Sanders R. Stabilization of acetabular fractures in elderly patients. J Bone Joint Surg Am. 1992;74(5):753–65.

    Article  CAS  PubMed  Google Scholar 

  31. Carroll EA, Huber FG, Goldman AT, Virkus WW, Pagenkopf E, Lorich DG, et al. Treatment of acetabular fractures in an older population. J Orthop Trauma. 2010;24(10):637–44.

    Article  PubMed  Google Scholar 

  32. Mears DC, Shirahama M. Stabilization of an acetabular fracture with cables for acute total hip arthroplasty. J Arthroplast. 1998;13(1):104–7.

    Article  CAS  Google Scholar 

  33. Sierra RJ, Mabry TM, Sems SA, Berry DJ. Acetabular fractures: the role of total hip replacement. The bone & joint journal. 2013;95-B(11 Suppl A):11–6.

    Article  CAS  Google Scholar 

  34. Berry DJ, Halasy M. Uncemented acetabular components for arthritis after acetabular fracture. Clin Orthop Relat Res. 2002;405:164–7.

    Article  Google Scholar 

  35. Bellabarba C, Berger RA, Bentley CD, Quigley LR, Jacobs JJ, Rosenberg AG, et al. Cementless acetabular reconstruction after acetabular fracture. J Bone Joint Surg Am. 2001;83-A(6):868–76.

    Article  CAS  PubMed  Google Scholar 

  36. •• Solomon LB, Studer P, Abrahams JM, Callary SA, Moran CR, Stamenkov RB, et al. Does cup-cage reconstruction with oversized cups provide initial stability in THA for osteoporotic acetabular fractures? Clin Orthop Relat Res. 2015;473(12):3811–9. This paper examines the use of a cup cage construct to add stability to the repair in acute total hip arthopalsty for fracture.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ranawat A, Zelken J, Helfet D, Buly R. Total hip arthroplasty for posttraumatic arthritis after acetabular fracture. J Arthroplast. 2009;24(5):759–67.

    Article  Google Scholar 

  38. Mouhsine E, Garofalo R, Borens O, Blanc CH, Wettstein M, Leyvraz PF. Cable fixation and early total hip arthroplasty in the treatment of acetabular fractures in elderly patients. J Arthroplast. 2004;19(3):344–8.

    Article  Google Scholar 

  39. Mears DC, Velyvis JH. Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results. J Bone Joint Surg Am. 2002;84-A(1):1–9.

    Article  PubMed  Google Scholar 

  40. Chakravarty R, Toossi N, Katsman A, Cerynik DL, Harding SP, Johanson NA. Percutaneous column fixation and total hip arthroplasty for the treatment of acute acetabular fracture in the elderly. J Arthroplast. 2014;29(4):817–21.

    Article  Google Scholar 

  41. Rickman M, Young J, Trompeter A, Pearce R, Hamilton M. Managing acetabular fractures in the elderly with fixation and primary arthroplasty: aiming for early weightbearing. Clin Orthop Relat Res. 2014;472(11):3375–82.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Enocson A, Blomfeldt R. Acetabular fractures in the elderly treated with a primary Burch-Schneider reinforcement ring, autologous bone graft, and a total hip arthroplasty: a prospective study with a 4-year follow-up. J Orthop Trauma. 2014;28(6):330–7.

    Article  PubMed  Google Scholar 

  43. Herscovici Jr D, Lindvall E, Bolhofner B, Scaduto JM. The combined hip procedure: open reduction internal fixation combined with total hip arthroplasty for the management of acetabular fractures in the elderly. J Orthop Trauma. 2010;24(5):291–6.

    Article  PubMed  Google Scholar 

  44. Lin C, Caron J, Schmidt AH, Torchia M, Templeman D. Functional outcomes after total hip arthroplasty for the acute management of acetabular fractures: 1- to 14-year follow-up. J Orthop Trauma. 2015;29(3):151–9.

    Article  PubMed  Google Scholar 

  45. Malhotra R, Singh DP, Jain V, Kumar V, Singh R. Acute total hip arthroplasty in acetabular fractures in the elderly using the octopus system: mid term to long term follow-up. J Arthroplast. 2013;28(6):1005–9.

    Article  Google Scholar 

  46. Romness DW, Lewallen DG. Total hip arthroplasty after fracture of the acetabulum. Long-term results. The Journal of bone and joint surgery British volume. 1990;72(5):761–4.

    CAS  PubMed  Google Scholar 

  47. Winemaker M, Gamble P, Petruccelli D, Kaspar S, de Beer J. Short-term outcomes of total hip arthroplasty after complications of open reduction internal fixation for hip fracture. J Arthroplast. 2006;21(5):682–8.

    Article  Google Scholar 

  48. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60(2):217–20.

    Article  CAS  PubMed  Google Scholar 

  49. Danoff JR, Bobman JT, Cunn G, Murtaugh T, Gorroochurn P, Geller JA, et al. Redefining the acetabular component safe zone for posterior approach Total hip arthroplasty. J Arthroplast. 2016;31(2):506–11.

    Article  Google Scholar 

  50. Zhang L, Zhou Y, Li Y, Xu H, Guo X, Zhou Y. Total hip arthroplasty for failed treatment of acetabular fractures: a 5-year follow-up study. J Arthroplast. 2011;26(8):1189–93.

    Article  Google Scholar 

  51. Lizaur-Utrilla A, Sanz-Reig J, Serna-Berna R. Cementless acetabular reconstruction after acetabular fracture: a prospective, matched-cohort study. The journal of trauma and acute care surgery. 2012;73(1):232–8.

    Article  PubMed  Google Scholar 

  52. Lai O, Yang J, Shen B, Zhou Z, Kang P, Pei F. Midterm results of uncemented acetabular reconstruction for posttraumatic arthritis secondary to acetabular fracture. J Arthroplast. 2011;26(7):1008–13.

    Article  Google Scholar 

  53. Dunet B, Tournier C, Billaud A, Lavoinne N, Fabre T, Durandeau A. Acetabular fracture: long-term follow-up and factors associated with secondary implantation of total hip arthroplasty. Orthopaedics & traumatology, surgery & research : OTSR. 2013;99(3):281–90.

    Article  CAS  Google Scholar 

  54. Kamath AF, Evangelista PJ, Nelson CL. Total hip arthroplasty with porous metal cups following acetabular fracture. Hip international : the journal of clinical and experimental research on hip pathology and therapy. 2013;23(5):465–71.

    Article  Google Scholar 

  55. Khurana S, Nobel TB, Merkow JS, Walsh M, Egol KA. Total hip arthroplasty for posttraumatic osteoarthritis of the hip fares worse than THA for primary osteoarthritis. Am J Orthop. 2015;44(7):321–5.

    PubMed  Google Scholar 

  56. Abolghasemian M, Tangsataporn S, Sternheim A, Backstein D, Safir O, Gross AE. Combined trabecular metal acetabular shell and augment for acetabular revision with substantial bone loss: a mid-term review. The bone & joint journal. 2013;95-B(2):166–72.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 531, Little Rock, AR, 72205, USA

    Kwan Jun Park & Simon C. Mears

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  1. Kwan Jun Park
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  2. Simon C. Mears
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Correspondence to Simon C. Mears.

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Simon Mears and Kwan Park declare no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Geriatric Orthopedics

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Park, K.J., Mears, S.C. A Review of Total Hip Replacement Following Acetabular Fractures. Curr Geri Rep 6, 1–8 (2017). https://doi.org/10.1007/s13670-017-0193-1

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