Related Experiment Video
Updated: Oct 19, 2025
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Acetabular Fractures with Central Hip Dislocation: A Retrospective Consecutive 50 Case Series Study Based on AO/OTA
Chun-Yen Chen1, Chin-Jung Hsu1,2, Tsung-Li Lin1,3,4
1Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan.
Insights
Surgical treatment for acetabular fractures with central hip dislocation yields good outcomes. Key risk factors for developing hip arthritis requiring total hip arthroplasty include male sex, initial impaction, and sciatic nerve injury.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Reconstructive Surgery
Background:
- Acetabular fractures, particularly those involving the medial wall and central hip dislocation, present significant management challenges.
- Secondary hip osteoarthritis often necessitates total hip arthroplasty (THA) following surgical treatment of these complex fractures.
Purpose of the Study:
- To investigate the clinical outcomes of surgical treatment for acetabular fractures with central hip dislocation.
- To identify risk factors associated with the development of secondary hip osteoarthritis requiring THA.
Main Methods:
- Retrospective review of 50 patients with AO/OTA 2018 62B/62C acetabular medial wall fractures and central hip dislocation treated between 2015-2017.
- Surgical reduction using the modified Stoppa with/without Kocher-Langenbeck (KL) approach, followed by a minimum 3-year follow-up.
- Functional evaluation using the Majeed scoring system and multivariate logistic regression to identify risk factors for THA.
Main Results:
- 70% of patients achieved good or excellent functional scores (Majeed).
- 22% of patients required THA due to end-stage posttraumatic arthritis within the follow-up period.
- Identified risk factors for THA included male sex, initial marginal impaction, and sciatic nerve injury. 5-year survivorship free from end-stage arthritis was 78%.
Conclusions:
- The modified Stoppa and KL approach is effective for acetabular medial wall fractures with central hip dislocation, offering satisfactory functional outcomes.
- Marginal impaction with articular damage, high axial loading trauma, and preoperative sciatic nerve injury are significant risk factors for developing end-stage arthritis.
- Occupational factors involving heavy manual labor and lifting in males may increase the risk of posttraumatic arthritis progression.
Introduction:
Management of acetabular fractures is challenging, especially when a medial acetabular fracture is complicated by central hip dislocation. We retrospectively investigated the clinical outcome and risk factors of secondary hip osteoarthritis requiring total hip arthroplasty after the surgical treatment of acetabular fractures with central hip dislocation.
Materials And Methods:
The medical records of all patients who had acetabular medial wall fractures with central hip dislocation treated with open reduction and internal fixation by a single surgeon between January 2015 and June 2017 were reviewed. Surgical reduction was performed with the modified Stoppa with/without the Kocher-Langenbeck (KL) approach. Patients were followed for a minimum of three years, and the Majeed scoring system was used for functional evaluation. Multivariate logistic regression analysis was used to assess the association of patients' characteristics with the likelihood of advanced posttraumatic arthritis developing with conversion to total hip arthroplasty.
Results:
Fifty patients were included in this study, with disease classified as AO/OTA 2018 62B/62C. Thirty-five patients (70%) had good or excellent Majeed pelvic scores. Eleven patients (22%) eventually received total hip arthroplasty because of end-stage posttraumatic arthritis. Three risk factors identified for total hip arthroplasty were male sex, initial marginal impaction, and sciatic nerve injury. Kaplan-Meier survivorship analysis estimated that the cumulative probability of free-from-end-stage arthritis was 78% (95% confidence interval, 73%-90%) at the 5-year follow-up.
Conclusion:
Surgical fixation with the modified Stoppa and the KL approach for acetabular medial wall fractures with central hip dislocation is an effective approach with a satisfactory functional outcome. A prodromal factor was marginal impaction concomitant with articular damage. The trauma of high axial loading and the occupational distribution (males performing heavy manual labor and heavy lifting) with preoperative sciatic nerve injury increased the odds of developing end-stage arthritis.
