Skip to main content
SpringerLink
Log in

Occult intra-operative periprosthetic fractures of the acetabulum may affect implant survival

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Occult intra-operative periprosthetic acetabular fracture is a seldom-reported complication of primary total hip arthroplasty (THA). It may potentially be associated with cup instability and implant loosening. The present study aimed to investigate clinical consequences of this complication.

Methods

Between 2003 and 2012, a total of 3390 cementless total hip arthroplasties (THA) were performed at our institution. Their medical histories were retrospectively reviewed to identify all patients who received a thin-layer computer tomography (CT) scan of the pelvis including the acetabulum within the first 30 post-operative days. They were evaluated and classified by two radiologists independently with respect to the presence of recent acetabular fractures. All cases with acetabular and periacetabular fractures were included in this study. Electronic medical records were reviewed to assess implant revision. Cup stability was measured with EBRA (Einzel-Bild-Röntgen-Analyse) from plain X-rays.

Results

Periprosthetic fractures of the acetabulum were identified in 58 (50.4%) of 115 selected patients. Fractures close to but not including the acetabulum were identified in 45% (n = 26/58) of the patients, at the superolateral wall in 17% (n = 10/58), at the anterior wall of the acetabulum in 16% (n = 9/58) and in 10% (n = 6/58) each at the medial wall, and at the posterior wall respectively. One out of these 58 fractures could not be classified. Three of a total of six occult medial wall fractures had to be revised, and another two showed a high implant migration. The highest cup migration values however were found after fractures of the superolateral wall. Incomplete column fractures did not influence implant survival.

Conclusion

Central wall acetabular fractures, although unrecognized intra- and post-operatively may impair implant survival after THA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kavanagh BF (1992) Femoral fractures associated with total hip arthroplasty. Orthop Clin N Am 23(2):249–257

    CAS  Google Scholar 

  2. Berry DJ (1999) Epidemiology: hip and knee. Orthop Clin N Am 30(2):183–190

    Article  CAS  Google Scholar 

  3. Jensen JS, Retpen JB (1987) Failures with the Judet noncemented total hip. Acta Orthop Scand 58(1):23–26

    Article  CAS  PubMed  Google Scholar 

  4. Mayle RE, Della Valle CJ (2012) Intra-operative fractures during THA: see it before it sees us. J Bone Joint Surg Br 94(11 Suppl A):26–31. https://doi.org/10.1302/0301-620X.94B11.30614

    Article  CAS  PubMed  Google Scholar 

  5. Schwartz JT Jr, Mayer JG, Engh CA (1989) Femoral fracture during non-cemented total hip arthroplasty. J Bone Joint Surg Am 71(8):1135–1142

    Article  PubMed  Google Scholar 

  6. Taylor MM, Meyers MH, Harvey JP Jr (1978) Intraoperative femur fractures during total hip replacement. Clin Orthop Relat Res 137:96–103

    Google Scholar 

  7. Ricioli W Jr, Queiroz MC, Guimaraes RP, Honda EK, Polesello G, Fucs PM (2015) Prevalence and risk factors for intra-operative periprosthetic fractures in one thousand eight hundred and seventy two patients undergoing total hip arthroplasty: a cross-sectional study. Int Orthop 39(10):1939–1943. https://doi.org/10.1007/s00264-015-2961-x

    Article  PubMed  Google Scholar 

  8. Haidukewych GJ, Jacofsky DJ, Hanssen AD, Lewallen DG (2006) Intraoperative fractures of the acetabulum during primary total hip arthroplasty. J Bone Joint Surg Am 88(9):1952–1956. https://doi.org/10.2106/JBJS.E.00890

    Article  PubMed  Google Scholar 

  9. Adler E, Stuchin SA, Kummer FJ (1992) Stability of press-fit acetabular cups. J Arthroplast 7(3):295–301

    Article  CAS  Google Scholar 

  10. Curtis MJ, Jinnah RH, Wilson VD, Hungerford DS (1992) The initial stability of uncemented acetabular components. J Bone Joint Surg Br 74(3):372–376

    Article  CAS  PubMed  Google Scholar 

  11. Kim YS, Callaghan JJ, Ahn PB, Brown TD (1995) Fracture of the acetabulum during insertion of an oversized hemispherical component. J Bone Joint Surg Am 77(1):111–117

    Article  CAS  PubMed  Google Scholar 

  12. Sharkey PF, Hozack WJ, Callaghan JJ, Kim YS, Berry DJ, Hanssen AD, LeWallen DG (1999) Acetabular fracture associated with cementless acetabular component insertion: a report of 13 cases. J Arthroplast 14(4):426–431

    Article  CAS  Google Scholar 

  13. Stiehl JB, MacMillan E, Skrade DA (1991) Mechanical stability of porous-coated acetabular components in total hip arthroplasty. J Arthroplast 6(4):295–300

    Article  CAS  Google Scholar 

  14. Hasegawa K, Kabata T, Kajino Y, Inoue D, Tsuchiya H (2017) Periprosthetic occult fractures of the acetabulum occur frequently during primary THA. Clin Orthop Relat Res 475(2):484–494. https://doi.org/10.1007/s11999-016-5138-z

    Article  PubMed  Google Scholar 

  15. Troelsen A, Malchau E, Sillesen N, Malchau H (2013) A review of current fixation use and registry outcomes in total hip arthroplasty: the uncemented paradox. Clin Orthop Relat Res 471(7):2052–2059. https://doi.org/10.1007/s11999-013-2941-7

    Article  PubMed  PubMed Central  Google Scholar 

  16. Peterson CA, Lewallen DG (1996) Periprosthetic fracture of the acetabulum after total hip arthroplasty. J Bone Joint Surg Am 78(8):1206–1213

    Article  CAS  PubMed  Google Scholar 

  17. Rehman H, Clement RG, Perks F, White TO (2016) Imaging of occult hip fractures: CT or MRI? Injury 47(6):1297–1301. https://doi.org/10.1016/j.injury.2016.02.020

    Article  PubMed  Google Scholar 

  18. Krismer M, Bauer R, Tschupik J, Mayrhofer P (1995) EBRA: a method to measure migration of acetabular components. J Biomech 28(10):1225–1236

    Article  CAS  PubMed  Google Scholar 

  19. https://www2.aofoundation.org/wps/portal/surgery?showPage=diagnosis&bone=Pelvis&segment=Acetabulum. Accessed 9 November 2017)

  20. Judet R, Judet J, Letournel E (1964) Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary Report. J Bone Joint Surg Am 46:1615–1646

    Article  CAS  PubMed  Google Scholar 

  21. Alton TB, Gee AO (2014) Classifications in brief: Letournel classification for acetabular fractures. Clin Orthop Relat Res 472(1):35–38. https://doi.org/10.1007/s11999-013-3375-y

    Article  PubMed  Google Scholar 

  22. Saterbak AM, Marsh JL, Turbett T, Brandser E (1995) Acetabular fractures classification of Letournel and Judet--a systematic approach. Iowa Orthop J 15:184–196

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Nogler M, Mayr E, Krismer M (2012) The direct anterior approach to the hip revision. Oper Orthop Traumatol 24(2):153–164. https://doi.org/10.1007/s00064-011-0113-z

    Article  CAS  PubMed  Google Scholar 

  24. https://www.strykermeded.com/media/1157/trident-acetabular-system-psl-surgical-protocol.pdf. Accessed 3 December 2017

  25. http://synthes.vo.llnwd.net/o16/LLNWMB8/INT%20Mobile/Synthes%20International/Product%20Support%20Material/legacy_DePuy_PDFs/DSEM-JRC-0615-0317_LR.pdf. Accessed 3 December 2017

  26. https://www.strykermeded.com/media/1158/trident-acetabular-system-hemispherical-surgical-protocol.pdf. Accessed 5 December 2017

  27. http://www.zimmer.com/content/dam/zimmer-web/documents/en-US/pdf/surgical-techniques/hip/zimmer-trilogy-it-acetabular-system-surgical-technique.pdf. Accessed 3 December 2017

  28. http://zimmerthomson.com/content/pdf/en-GB/allofit_allofit_s_alloclassic_acetabular_cup_system_surgical_technique.pdf. Accessed 3 December 2017

  29. Callaghan JJ (1998) Periprosthetic fractures of the acetabulum during and following total hip arthroplasty. Instr Course Lect 47:231–235

    CAS  PubMed  Google Scholar 

  30. Della Valle CJ, Momberger NG, Paprosky WG (2003) Periprosthetic fractures of the acetabulum associated with a total hip arthroplasty. Instr Course Lect 52:281–290

    PubMed  Google Scholar 

  31. Davidson D, Pike J, Garbuz D, Duncan CP, Masri BA (2008) Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am 90(9):2000–2012. https://doi.org/10.2106/JBJS.H.00331

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    Dietmar Dammerer, Ferdi Arrich, Martin Krismer & Rainer Biedermann

  2. Department of Orthopaedics—Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria

    David Putzer

  3. Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    Bernhard Glodny & Johannes Petersen

Authors
  1. Dietmar Dammerer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Putzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bernhard Glodny
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johannes Petersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ferdi Arrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martin Krismer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rainer Biedermann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rainer Biedermann.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The local ethics committee approved the study.

Informed consent

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dammerer, D., Putzer, D., Glodny, B. et al. Occult intra-operative periprosthetic fractures of the acetabulum may affect implant survival. International Orthopaedics (SICOT) 43, 1583–1590 (2019). https://doi.org/10.1007/s00264-018-4084-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-018-4084-7

Keywords

Search

Navigation