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Cementless acetabular reconstruction after acetabular fracture
C Bellabarba1, R A Berger, C D Bentley
1Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA. cbella@u.washington.edu
The Journal of Bone and Joint Surgery. American Volume
|June 16, 2001
Summary
Total hip arthroplasty using cementless acetabular reconstruction yields similar intermediate-term results for posttraumatic and nontraumatic arthritis. However, posttraumatic cases, especially those with prior open reduction, involve longer procedures and greater blood loss.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Trauma Reconstruction
Background:
- Posttraumatic arthritis after acetabular fracture often leads to inferior total hip arthroplasty (THA) outcomes compared to nontraumatic arthritis.
- Cementless acetabular reconstruction in this context requires further investigation.
Purpose of the Study:
- Compare intermediate-term THA results using cementless acetabular components in posttraumatic vs. nontraumatic arthritis.
- Evaluate the impact of prior operative (open reduction) versus closed treatment of acetabular fractures on THA outcomes.
Main Methods:
- Thirty THAs with cementless acetabular components for posttraumatic osteoarthritis were analyzed.
- Patients were divided into groups based on prior acetabular fracture treatment: open reduction (n=15) vs. closed treatment (n=15).
- Results were compared to 204 primary THAs for nontraumatic arthritis with cementless reconstruction.
Main Results:
- Posttraumatic arthritis THA involved longer operative times, greater blood loss, and higher transfusion needs than nontraumatic cases.
- Prior open reduction for acetabular fractures led to significantly longer procedures, more blood loss, and higher transfusion requirements compared to closed treatment.
- Despite increased operative demands, 90% of posttraumatic arthritis patients achieved good or excellent results, with a 10-year survival rate of 97%.
Conclusions:
- Cementless acetabular reconstruction in THA for posttraumatic osteoarthritis provides intermediate-term results comparable to those for nontraumatic arthritis.
- Prior open reduction of acetabular fractures increases operative complexity (longer duration, more blood loss) but may reduce bone deficiency.
- THA after acetabular fracture is a viable option with good long-term survival, irrespective of initial fracture treatment.