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[Causes and managements of acetabular fracture during primary total hip arthroplasty]
Liming Song1, Tieliang Zhang, Jianhua Yu
1Department of Joint Surgery, Tianjin Hospital, Tianjin 300211, PR China. sososlm@126.com
Insights
Acetabular fractures during primary total hip arthroplasty (THA) can be managed effectively. Careful preoperative planning and precise surgical techniques, along with appropriate fixation like augmentation screws or bone grafting, lead to good clinical outcomes.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Trauma Surgery
Context:
- Acetabular fractures are a potential complication during primary total hip arthroplasty (THA).
- Understanding the causes and effective management strategies is crucial for successful patient outcomes.
- Prevalence is associated with factors like developmental dysplasia of the hip and rheumatoid arthritis.
Purpose:
- To investigate the causes and management of acetabular fractures occurring during primary total hip arthroplasty (THA).
- To evaluate the clinical results of different management strategies for these fractures.
Summary:
- Nine patients experienced acetabular fractures during cementless THA, with various underlying conditions.
- Stable fractures were managed with augmentation screws or observation; unstable fractures required bone grafting and screws.
- Postoperative X-rays showed favorable prosthesis positioning, and patients achieved significantly improved Harris scores with fracture healing and no loosening.
Impact:
- This study highlights the importance of meticulous preoperative assessment and surgical technique to minimize acetabular fracture risk during THA.
- Appropriate intraoperative management, including augmentation screws or bone grafting, can lead to excellent functional recovery.
- Findings provide guidance for orthopedic surgeons managing acetabular fractures in the context of primary THA.
Objective:
To investigate the causes and managements of acetabular fracture during primary total hip arthroplasty (THA).
Methods:
Between May 2005 and July 2008, 9 patients (9 hips) suffered from acetabular fractures during primary THA. There were 1 male and 8 females with an average age of 63.3 years (range, 41-73 years), including 4 cases of developmental dysplasia of the hip, 2 cases of rheumatoid arthritis, 1 case of old femoral neck fracture, 1 case of avascular necrosis of femoral head, and 1 case of ankylosing spondylitis. Three left hips and 6 right hips were involved. The preoperative Harris score was 40.4 +/- 2.9. All the patients underwent cementless THA. Among nine acetabular fractures, 8 fractures were stable (2 anterior wall fractures and 6 posterior wall fractures), which were fixed by additional augmentation screws in 7 cases and accepted no special treatment in 1 case; 1 fracture was unstable (posterior wall fracture with posterior column incomplete fracture), which was treated by bone grafting and additional screws.
Results:
The postoperative X-ray films showed that the position of the prosthesis were favorable. All incisions healed by first intention without early complication. Nine patients were followed up 1-4 years (mean, 2 years and 7 months). The Harris score was 87.8 +/- 3.9 at last follow-up, showing significant difference when compared with the preoperative score (t = 44.904, P = 0.000). The X-ray films showed fracture healing at 8 weeks. No loosening occurred.
Conclusion:
When primary THA is performed, the preoperative X-ray film should be studied and measured carefully, operation should be accurate and violence should be avoided. The diameter of the acetabular component should be equal to the diameter of a drill or not larger than 2 mm. In patients with severe osteoporosis, the diameter of the acetabular components should be the same diameter as a drill and additional screws are used to fix, or cemented cup is used. Once an acetabular fracture occurs during the primary THA, additional screw or bone grafting with additional screws should be chosen according to the fracture type and stability, and good clinical results can be expected.
