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Clinical impact of intraoperative cone beam tomography and navigation for displaced acetabular fractures: a comparative study at medium-term follow-up

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Abstract

Introduction

The use of per-operative cone beam tomography imaging for displaced acetabular fractures yields increased post-operative articular reduction accuracy. This study evaluates the need for total hip replacement (THR) and hip-related functional outcomes in patients with displaced acetabular fractures treated with O-ARM guidance compared to those treated under C-ARM guidance.

Materials and methods

This is a prospective matched cohort study. Adult patients (35) with acetabular fractures operated under O-ARM guidance were included. These were matched (age, fracture type) to classically treated patients (35) from our data base. The primary outcome was the need for THR during three year follow-up period. Secondary outcomes were functional scores [Harris Hip score (HHS), Postel-Merle d’Aubigné (PMA)] and hip osteoarthritis grade at three year follow-up. Correlation between reduction gap and THR was evaluated.

Results

At three years, five patients were lost to follow-up in O-ARM group and four in control group. Two patients (6.66%) in the O-ARM group needed THR compared to eight patients in controls (25.80%) (p = 0.046). Hip X-ray osteoarthritis grade averaged 0.00 in patients without THR in O-ARM group compared to 0.22 in patients without THR in controls (p = 0.008). HHS averaged 95.79 in patients without THR in O-ARM group, compared to 93.82 in patients without THR in the control group (p = 0.41%). PMA averaged 17.25 in patients without THR in the O-ARM group compared to 17.04 in patients without THR in group 2 (p = 0.37). Evaluation of correlation between reduction gap and THR rate yielded OR = 1.22 (1.06–1.45).

Discussion

Increased accuracy in articular reduction, with per-operative three-dimensional control of impaction, in acetabular fractures led to significantly less need for THR in patients treated under O-ARM. Patients in both groups are comparable for functional outcomes because those with the lowest scores were offered THR. Per-operative cone beam guidance and navigation use are recommended in tertiary referral centres for acetabular trauma.

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Data Availability

Data and material are available.

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Funding

There was no funding received for this study.

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Authors and Affiliations

  1. Orthopedic Surgery Department, Groupe Hospitalier Paris Saint Joseph, 185, Rue Raymond Losserand, Paris, 75014, France

    Maroun Rizkallah, Elias Melhem, Pierre-Emmanuel Moreau, Peter Upex, Pomme Jouffroy & Guillaume Riouallon

  2. Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon

    Maroun Rizkallah & Amer Sebaaly

  3. Faculty of Medicine, University of Paris, Alliance Sorbonne-Paris-Cité, Paris, France

    Maroun Rizkallah

Authors
  1. Maroun Rizkallah
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  2. Amer Sebaaly
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  3. Elias Melhem
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  4. Pierre-Emmanuel Moreau
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  5. Peter Upex
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  6. Pomme Jouffroy
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  7. Guillaume Riouallon
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Contributions

MR participated in data collection, designing the work and drafting of the manuscript. AS participated in data collection, work design and approving the final manuscript. EM participated in statistical analysis and reviewing the manuscript.PEM participated in drafting manuscript and analyzing collected data.PU participated in drafting manuscript and analyzing collected data.PJ participated in designing the work, drafting the manuscript and reviewing the final manuscript. GR is the main conceptor of the study and participated in drafting the manuscript

Corresponding author

Correspondence to Maroun Rizkallah.

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This is a retrospective study on prospectively collected data involving humans.

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This article was approved by the IRB of our institution.

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Informed consent was obtained from all individual participants included in the study.

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All included patients consented to participate in this study.

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The authors declare no competing interests.

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Level of evidence : therapeutic level III

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Rizkallah, M., Sebaaly, A., Melhem, E. et al. Clinical impact of intraoperative cone beam tomography and navigation for displaced acetabular fractures: a comparative study at medium-term follow-up. International Orthopaedics (SICOT) 45, 1837–1844 (2021). https://doi.org/10.1007/s00264-021-05076-4

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