Management of Acetabular Fractures by Prosthetic Hip Replacement
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- Category: Vol. 82, March 2014
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Management of Acetabular Fractures by Prosthetic Hip Replacement, ABDULLAH AL-ZAHRANI
Abstract
Total hip arthroplasty (THA) in the setting of an acetabular fracture remains a difficult reconstructive dilemma. The procedure is much more difficult than a regular THA for degenerative arthritis especially on the acetabular side mainly due to the presence of bone defects, nonunions and may be obstructive hardware and HO.
We Aim to: 1- Express these difficulties and the methods used to overcome them, 2- Report on the early results of these cases regarding the functional outcome, complications and revision surgeries, and 3- Correlate these outcomes with the different variables including the age, previous treatment and method of fixation of the acetabular component.
Patients and Methods: From this view the procedure may resemble a revision surgery and should be dealt with as one.
Results: 44 patients 30 males and 14 females were operated upon with mean age 50.8 years. They were divided into ORIF group (17 cases), non-ORIF group (11 cases) and early THA group (16 cases). We had defects in 41 cases (more in non-ORIF than ORIF group) ranging between cavitary deficiencies in 11 cases, segmental in 10 cases, combined in 12 cases and pelvic discontinuity in 8 cases. Autologous femoral head bone graft was used in 38 cases. Impaction allografts were used to fill defects in 3 cases. Augmentation devices were used in 6 cases; a rim mesh in 4 cases, a floor mesh in 1 case and a Müller ring in 1 case. Other methods used included a high hip center in 1 case and reduction and fixation of the fracture in 9 cases. Moreover, nonunions were more common among the non-ORIF group. Other pre-operative complications included partial sciatic nerve injury in 5 cases, HO in 10 cases and obstructive hardware in 11 cases which mandated its removal. The average post-operative Harris hip score was 83.4 (range 35-95) at the latest follow-up. 33 (75%) patients had good or excellent Harris hip scores at their latest follow-up, 4 (9. 1 %) had fair scores, and 3 (6.8%) had poor scores.
Conclusion: Our results were comparable to the recently published series; however they are still inferior to the results of THA done for degenerative arthritis.