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Predictors for secondary hip osteoarthritis after acetabular fractures—a pelvic registry study

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Abstract

Purpose

Secondary hip osteoarthritis after acetabular fractures requiring total arthroplasty (THA) poses a huge burden on the affected patients as well as health systems. The present study aimed to assess risk factors associated with THA after acetabular fractures based on the data from the German Pelvic Trauma Registry.

Methods

Retrospective analysis of 678 acetabular fracture cases without concomitant pelvic ring fracture treated and followed-up between January 2004 and May 2015 at six large trauma centres. Multivariate Cox regression analysis was performed assessing the association of patient/treatment characteristics with THA likelihood at an average follow-up of 2.7 years (range 0.4–9.5 years; SD 1.8 years).

Results

Overall, the rate of secondary osteoarthritis was 19.8%. The likelihood for THA increased with 6% per age year (95% CI 1.04–1.09) and with 21% per millimetre subluxation (95%CI 1.09–1.33). This likelihood was 3.54 (95% CI 1.77–7.08) and 3.68 times (95% CI 1.87–7.47) higher if the posterior wall was involved and a contusion and/or impaction of the femoral head was present. Other covariates (sex, ISS, trauma type, AO/OTA and Letournel classification, initial displacement, surgical approach, intra-articular fragments, contusion and/or impaction to the acetabulum, reduction, intervention type, duration of surgery, soft tissue damage, residual fracture step/gap, and prevention of heterotopic ossifications) were not significantly associated (p > 0.15).

Conclusions

Twenty percent of patients with acetabular fractures require THA. The associated risk factors are patient age, femoral head lesion/subluxation, and involvement of the posterior wall. The identified risk factors support previous research and should be minded when treatment of acetabular fractures is planned.

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Acknowledgments

We thank all members of the Pelvic Trauma Working Group of the German Trauma Association, who continuously invest a lot of time and effort in scientific projects and the procurement of knowledge leading to a continuous improvement of the standards of care for patients with pelvic and acetabular fractures in Germany. Without their efforts, the German Pelvic Trauma Registry and this study would not have been possible.

Institutions contributing to the German Pelvic Trauma Registry include the following: ZNA Stuivenberg Antwerpen, Belgium; AZ Groeninge Hospital, Kortrijk, Belgium; Jolimont-Lobbes Hospital, Lobbes, Belgium; University Hospital Aachen, Aachen, Germany; General Hospital Augsburg, Germany; Charité Campus Virchow Hospital, Berlin, Germany; Kreisklinik Biberach, Germany; Municipal Hospital, Braunschweig, Germany; General Hospital, Celle, Germany; General Hospital Dortmund, Germany; Diakonissenkrankenhaus, Flensburg, Germany; University Hospital, Freiburg, Germany; BG Trauma Hospital, Halle, Germany; University Hospital, Halle, Germany; University Hospital, Hamburg, Germany; Friederikenstift Hospital, Hannover, Germany; Medizinische Hochschule, Hannover, Germany; University Hospital, Homburg, Germany; University Hospital, Jena, Germany; Westpfalz Hospital, Kaiserslautern, Germany; Municipal Hospital Karlsruhe, Germany; University Hospital, Kiel, Germany; SKM Hospital, Koblenz, Germany; University Hospital, Leipzig, Germany; General Hospital, Ludwigsburg, Germany; BG Trauma Hospital, Ludwigshafen, Germany; University Hospital, Mainz, Germany; University Hospital, Magdeburg, Germany; Hospital of the Technical University, Munich, Germany; BG Trauma Hospital, Murnau, Germany; University Hospital, Münster, Germany; Municipal Hospital Nuernberg, Germany; University Hospital, Regensburg, Germany; Klinikum Schwerin, Germany; BG Trauma Hospital, Tübingen, Germany; German Army Hospital, Ulm, Germany; University Hospital, Ulm, Germany; and Sahlgrenska University Hospital, Gothenburg, Sweden.

Funding

An unrestricted institutional grant was received by the Deutsche Arthrosehilfe e.V. to complete the scientific study at the Study Center—UKS Trauma—of the Department of Trauma, Hand and Reconstructive Surgery, Saarland University.

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Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg/Saar, Germany

    Mika F. Rollmann, Jörg H. Holstein, Tim Pohlemann, Steven C. Herath, Tina Histing & Benedikt J. Braun

  2. Department of Orthopaedics and Traumatology, Odense University Hospital, University of Southern Denmark, Søndre Blvd. 29, 5000, Odense C, Denmark

    Hagen Schmal

  3. Department of Orthopaedic and Trauma Surgery, AZ Groeninge, B. Vercruysselaan 5, 8500, Kortrijk, Belgium

    Guy Putzeys

  4. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany

    Ivan Marintschev

  5. Spine Centre Division, Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

    Emin Aghayev

Authors
  1. Mika F. Rollmann
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  2. Jörg H. Holstein
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  3. Tim Pohlemann
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  4. Steven C. Herath
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  6. Benedikt J. Braun
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  7. Hagen Schmal
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  9. Ivan Marintschev
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  10. Emin Aghayev
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Corresponding author

Correspondence to Mika F. Rollmann.

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Conflict of interest

Tim Pohlemann is the head of the TK system of the AO Foundation (nonprofit). Those activities are unrelated to the presented topic. All other authors declare that they have no conflict of interest.

Additional information

The German Pelvic Trauma Registry of the German Association of Trauma Surgery (DGU)

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Rollmann, M.F., Holstein, J.H., Pohlemann, T. et al. Predictors for secondary hip osteoarthritis after acetabular fractures—a pelvic registry study. International Orthopaedics (SICOT) 43, 2167–2173 (2019). https://doi.org/10.1007/s00264-018-4169-3

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  • DOI: https://doi.org/10.1007/s00264-018-4169-3

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