Combined surgical management of periprosthetic acetabular fractures: a retrospective study

Periprosthetic acetabular fractures (PPAF) are a rare and serious complication in hip arthroplasty. The increase in the number of hip arthroplasty patients and the long service life of implants are leading to a rise in periprosthetic fractures.

We hypothesized (1) that modified Stoppa approach in Combination with direct anterior approach of PPAF leads to good patient outcomes in both patients with and without acetabular cup instability; (2) the complication rate of our combined surgical procedures is lower than reported in the literature; (3) that combined surgical procedures for PPAF have a low 1-year mortality.

A retrospective analysis was performed from January 2013 to February 2024. Patients were treated with osteosynthesis using the modified Stoppa approach and revision of the cup using the direct anterior approach (DAA). Mobility before and after surgical treatment, modified Harris Hip Score (mHHS), complications, revision rates, and 1-year mortality were recorded using a questionnaire.

A total of 24 PPAF were identified, of which 18 patients were included in this study. Of 18 PPAF that were treated interdisciplinary by the trauma and orthopedic department, 13 cases showed cup instability. Fifty percent of the patients achieved a satisfactory result after mHHS, however, with a mean mHHS of 57±30, showing a wide range between good and poor outcomes. 13 (61.1 %) patients reported the same mobility postoperatively as prior to fracture. The complication and revision rates were 16.6 % and 5.6 %, respectively, which is below the rates reported in the literature. The 1-year mortality rate was 33.3 %.

Combined surgery showed low perioperative complication and revision rates. However, a 1/3 mortality rate at 1 year is quite high, which is likely a reflection of these patients' fragility and co-morbidities. Furthermore, there is no advantage for the functional outcome according to the mHHS.