Total hip replacement in complex acetabular fractures using a coned hemipelvic acetabular component
Samuel E McMahon1, Laurence A Cusick2
1Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland, UK. sammc84@gmail.com.
Insights
This study introduces a new coned hemipelvic acetabular component for treating elderly acetabular fractures, enabling early weight-bearing and promising functional outcomes with minimal complications.
Area of Science:
- Orthopedic Surgery
- Geriatric Trauma
- Arthroplasty
Background:
- Acetabular fractures in the elderly present significant challenges due to osteoporosis and comorbidities.
- These fractures are linked to poor functional results and increased mortality.
- Current treatments include conservative management, open reduction internal fixation, and total hip arthroplasty.
Purpose of the Study:
- To present the surgical technique and early outcomes of using a coned hemipelvic acetabular component for primary treatment of acetabular fractures in elderly patients.
- To evaluate the safety and efficacy of this novel approach in improving functional recovery.
Main Methods:
- A prospective study involving five elderly patients (six cases) with a mean age of 75 years.
- Surgical technique involved the implantation of a coned hemipelvic acetabular component.
- Patients were followed up for 15 months, assessing complications, mobility, and radiological outcomes.
Main Results:
- Four out of five patients achieved independent ambulation with a walking aid at latest follow-up.
- Early weight-bearing mobilization was possible on postoperative day one for four patients.
- Minor complications included wound ooze, acute kidney injury, and respiratory infection; no dislocations, infections, or prosthesis migration occurred.
Conclusions:
- The coned hemipelvic acetabular component provides an immediately stable construct, facilitating early mobilization.
- This technique shows promising early results for treating complex acetabular fractures in the elderly.
- Further long-term monitoring is recommended to confirm sustained benefits and safety.
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.
