Abstract
Acetabular fractures in the elderly are a challenging clinical problem due to both the complex nature of operative intervention, osteoporotic bone and the multiple comorbidities of the patients involved. They are associated with poor functional outcomes and high levels of morbidity and mortality. Treatment currently ranges from conservative treatment, open reduction internal fixation and variations of total hip arthroplasty. We present the surgical technique and early results of the use of a coned hemipelvic acetabular component in the primary treatment of these complex injuries. Five patients (six cases) with a mean age of 75 years have been followed up for 15 months. There were five minor post-operative complications: two patients suffered mild serous wound ooze, two sustained an acute kidney injury, and one a lower respiratory tract infection. One patient suffered pre-operative bilateral sciatic nerve injury, which has partially resolved. There have been no thromboembolic events, dislocations or infections. There have been no cases of prosthesis migration. Four of five patients were able to mobilise fully weight-bearing day one post-operatively, and at latest follow-up four of five mobilised independently with a walking aid. We feel that early weight-bearing mobilisation is essential to achieve a successful outcome in these patients, in a similar way to neck of femur fracture patients. The coned acetabular prosthesis bypasses the fracture, creating an immediately stable construct which allows mobilisation day one post-operatively. The early results of this new technique are promising. Although follow-up is short, there have been no serious complications, a high level of patient satisfaction and radiological evidence of fracture healing, with no prosthesis migration. We aim to continue utilising this technique, with close monitoring of longer-term results.
Similar content being viewed by others
References
Daurka JS, Pastides PS, Lewis A, Rickman M, Bircher MD (2014) Acetabular fractures in patients aged >55 years: a systematic review of the literature. Bone Jt J 96-B(2):157–163
Vanderschot P (2007) Treatment options of pelvic and acetabular fractures in patients with osteoporotic bone. Injury 38(4):497–508
Ferguson T, Patel R, Bhandari M, Matta JM (2002) Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Jt Surg [Br] 92-B:250–257
Ochs B, Marintschev I, Hoyer H, Rolauffs B, Culemann U, Pohlemann T, Stuby FM (2010) 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 41:839–851
Peter RE (2015) Open reduction and internal fixation of osteoporotic acetabular fractures through the ilioinguinal approach: use of buttress plates to control medial displacement of the quadrilateral surface. Injury 46(Suppl 1):S2–S7
Carroll EA, Huber FG, Goldman AT, Virkus WW, Pagenkopf E, Lorich DG, Helfet DL (2010) Treatment of acetabular fractures in an older population. J Orthop Trauma 24(10):637–644
Sierra RJ, Mabry TM, Sems SA, Berry DJ (2013) Acetabular fractures: the role of total hip replacement. Bone Jt J 95–B(11 Suppl A):11–16
Boelch SP, Jordan MC, Meffert RH, Jansen H (2016) Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures: a retrospective clinical study. Int Orthop Aug 10 [Epub ahead of print]
De Bellis UG, Legnani C, Calori GM (2014) Acute total hip replacement for acetabular fractures: a systematic review of the literature. Injury 45(2):356–361
Butterwick D, Papp S, Gofton W, Liew A, Beaule PE (2015) Acetabular fractures in the elderly: evaluation and management. J Bone Jt Surg [Am] 97(9):758–768
Kamath AF, Evangelista PJ, Nelson CL (2013) Total hip arthroplasty with porous metal cups following acetabular fracture. Hip Int 23(5):465–471
Stihsen C, Hipfl C, Kubista B, Funovics PT, Dominkus M, Giurea A, Windhager R (2016) Review of the outcomes of complex acetabular reconstructions using a stemmed acetabular pedestal component. Bone Jt J 98-B:772–779
Schoellner C, Schoellner D (2000) Pedestal cup operation in acetabular defects after hip cup loosening, a progress report. Z Orthop Ihre Grenzgeb 138:215–221 (In German)
Matharu GS, Mehdian R, Sethi D, Jeys L (2013) Severe pelvic bone loss treated using a coned acetabular prosthesis with a stem extension inside the ilium. Acta Orthop Belg 79:680–688
Siu AL, Penrod JD, Boockvar KS, Koval K, Strauss E, Morrison RS (2006) Early ambulation after hip fracture: effects on function and mortality. Arch Intern Med 166(7):766–771
Weber M, Berry DJ, Harmsen WS (1998) Total hip arthroplasty after operative of an acetabular fracture. J Bone Jt Surg [Am] 80(9):1295–1305
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
McMahon, S.E., Cusick, L.A. Total hip replacement in complex acetabular fractures using a coned hemipelvic acetabular component. Eur J Orthop Surg Traumatol 27, 631–636 (2017). https://doi.org/10.1007/s00590-017-1903-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-017-1903-2